Improved outcomes with TKI maintenance after brexucabtagene autoleucel in Philadelphia chromosome ALL
Year: 2026
Type: article
Study design: Observational Study
Abstract: ABSTRACT: Brexucabtagene autoleucel (brexu-cel) produces high rates of measurable residual disease-negative (MRD-) complete response (CR) in adult patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL); however, subsequent relapses remain frequent. It is unclear whether maintenance with tyrosine kinase inhibitors (TKIs) can enhance remission durability. We evaluated outcomes among adult patients with relapsed/refractory Ph+ ALL who received commercial brexu-cel and achieved MRD- CR across 19 US institutions. Considering TKI maintenance as a time-varying covariate, we analyzed outcomes based on receipt of subsequent TKI maintenance vs no maintenance. Patients receiving consolidative transplantation or non-TKI maintenance were excluded. Fifty-one patients were included: 20 received TKI maintenance, and 31 received no maintenance. The use of TKI maintenance was associated with a significantly lower 1-year cumulative incidence of relapse (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.02-0.88; P = .037), which translated into improved progression-free survival (PFS; HR, 0.19; 95% CI, 0.04-0.85; P = .029) and a trend toward improved overall survival (HR, 0.34; 95% CI, 0.07-1.62; P = .18). There was no difference in nonrelapse mortality (HR, 0.83; 95% CI, 0.12-5.87; P = .85). This real-world analysis supports the administration of TKI maintenance in Ph+ ALL after achievement of MRD- CR with brexu-cel as a strategy to improve PFS after chimeric antigen receptor T-cell therapy.
Source: Blood Advances
Authors: Tamer Othman, Gregory W. Roloff, Katharine Miller, Amy Zhang, Katherine C. Sutherland, Rawan Faramand, LaQuisa C. Hill, Ibrahim N. Muhsen, Nikeshan Jeyakumar, Abdullah Ladha, Josh Sasine, Chenyu Lin, Noam E. Kopmar, Stephanie B. Tsai, Timothy E. O'Connor, Talal Hilal, Melhem M. Solh, Caitlin Guzowski, Virginia Tan, Navneet S. Majhail, Minoo Battiwalla, Shahbaz Malik, John Mathews, Paul Shaughnessy, Luke Mountjoy, Kaitlyn C. Dykes, Aaron C. Logan, Marc Schwartz, Matthew P. Connor, Jiasheng Wang, Sumithira Vasu, Muthu Kumaran, Rasmus Hoeg, Sean I. Tracy, Fevzi Yalniz, George Yaghmour, Vinod Pullarkat, Ryan D. Cassaday, Jessica T. Leonard, Bijal D. Shah, Noelle V. Frey, Lori S. Muffly, Ibrahim Aldoss
Institutions: City Of Hope National Medical Center, City of Hope, University of Chicago, Stanford Medicine, Stanford University, Moffitt Cancer Center, Houston Methodist, Baylor College of Medicine, University of Southern California, USC Norris Comprehensive Cancer Center, Cedars-Sinai Medical Center, Duke University Health System, University of Washington, Loyola University Medical Center, Loyola Medicine, Mayo Clinic in Arizona, Northside Hospital, Oregon Health & Science University, OHSU Knight Cancer Institute, Centennial Medical Center, St David's Medical Center, Medical City Dallas Hospital, Methodist Healthcare, Colorado Blood Cancer Institute, University of California San Diego, University of California, San Francisco, University of Colorado Anschutz, University of Pennsylvania, The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, University of Arkansas Medical Center, University of California Davis Medical Center, University of California, Davis, University of Minnesota, University of Kentucky
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,800
OpenAlex ID: W7165859607