The ZUMA-2 studies of brexucabtagene autoleucel (brexu-cel) found improved survival and duration of response compared to standard of care. Real-world data presented by Swetha Kambhampati, MD, of the City of Hope National Medical Center in Duarte, California, at the 2023 American Society of Clinical Oncology Annual Meeting revealed that outcomes of brexu-cel treatment remained consistent, regardless of prior therapy, in patients with mantle cell lymphoma (MCL).
The study evaluated data from the Center for International Blood and Marrow Transplant Research database, which includes 79 treatment centers. The sample included 272 patients receiving brexu-cel for relapsed or refractory MCL from July 2020 to August 2022. These patients were mostly male (78%), with a median age of 65.8 years. They also had a median of four lines of prior therapy, including Bruton’s tyrosine kinase (BTK) inhibition (87%), bendamustine (54%), and autologous hematopoietic stem cell transplantation (AHSCT; 31%).
Before chimeric antigen receptor (CAR) T-cell infusion, most patients had clinically significant comorbidities (76%) but very few (4%) had central nervous system involvement. The median time from leukapheresis to infusion was 28 days, and 18% of patients received bridging therapy during the wait.
Many patients experienced the most common side effects of CAR T-cell therapy: cytokine release syndrome (9%) and immune effector cell–associated neurotoxicity syndrome (27%), with most events resolving within a few weeks. Cytopenia lingered in 23% of the patients.
At a median follow-up of 6.6 months, the overall response rate (ORR) was 89%, and the complete response (CR) rate was 78%. Relapse or progression occurred in 21% of patients. The researchers then examined survival by subgroup, according to prior therapy received:
- Those who had received BTK inhibition had an ORR of 89% compared with 85% in those who had not received BTK inhibition.
- Those who had received bendamustine had an ORR of 88% compared with 89% in those who had not received it.
- Those who had underwent AHSCT had an ORR of 90% compared with 88% in those who did not.
- Patients who received brexu-cel as a second- or third-line therapy had better outcomes than those who received it as a fourth-line or later treatment: The CR rate was 91% versus 74%, respectively, and the ORR was 92% versus 88%, respectively.
Safety was similar regardless of whether patients had received prior BTK inhibition or AHSCT. However, those who had received bendamustine had less grade ≥3 neurotoxicity (19% vs 36%) but more cytopenia (29% vs 16%) compared with patients who had not been treated with bendamustine.
“These early findings suggest that real-world outcomes of brexu-cel are consistent regardless of prior BTK inhibition, bendamustine, or AHSCT,” the authors concluded. “Use of brexu-cel in earlier lines may help achieve a higher CR rate.”
Kambhampati S, Ahmed N, Hamadani M, et al. Real-world outcomes of brexucabtagene autoleucel (brexu-cel) for relapsed or refractory (R/R) mantle cell lymphoma (MCL): a CIBMTR subgroup analysis by prior treatment. Abstract #7507. Presented at the 2023 American Society of Clinical Oncology Annual Meeting; June 2-6, 2023; Chicago, Illinois.