Brexucabtagene autoleucel versus allogeneic hematopoietic cell transplantation in relapsed and refractory mantle cell lymphoma

Abstract Brexucabtagene autoleucel (brexu-cel) and allogeneic hematopoietic cell transplantation (alloHCT) are effective treatments for relapsed or refractory mantle cell lymphoma (r/r MCL), but the optimal choice remains unclear. We conducted an analysis of 64 r/r MCL patients aged ≥50 years treated with brexu-cel in the ZUMA-2 study, matching them 1:1 by propensity score to 64 (out of 272) r/r MCL patients who underwent alloHCT using data from the EBMT registry. Median follow-up time was 36.5 and 34.1 months for the brexu-cel and matched alloHCT cohort, respectively. Brexu-cel patients had a significantly higher overall survival (OS, 81.3% vs 59.2%, HR: 0.39, p=0.004) and lower non-relapse mortality (3.6% vs 21.2%, p=0.015) one year after treatment. Chronic graft-vs-host disease occurred in 26.9% of alloHCT patients within the first year. However, long-term progression-free survival and OS remain comparable. Despite limitations of this non-randomized study, it indicates a superior safety profile for brexu-cel in r/r MCL.