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 patients aged ≥50 years with r/r MCL treated with brexu-cel in the ZUMA-2 study, matching them 1:1 by propensity score to 64 (of 272) patients with r/r MCL who underwent alloHCT using data from the European Society for Blood and Marrow Transplantation registry. The median follow-up time was 36.5 months for the brexu-cel cohort and 34.1 months for the matched alloHCT cohort. Patients who received brexu-cel had a significantly higher overall survival [(OS) 81.3% vs. 59.2%; HR, 0.39; P = 0.004] and lower nonrelapse mortality (3.6% vs. 21.2%; P = 0.015) 1 year after treatment. Chronic GVHD occurred within the first year in 26.9% of patients who underwent alloHCT. However, long-term progression-free survival (PFS) and OS remain comparable. Despite the limitations of this nonrandomized study, the findings indicate a superior safety profile for brexu-cel in r/r MCL.

Significance:

Patients aged ≥50 years with r/r MCL had superior OS and lower nonrelapse mortality 1 year after receiving brexu-cel compared with alloHCT. However, the long-term PFS and OS are similar for both treatments. Individual risk–benefit evaluation is essential to guide optimal treatment decisions.

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©2025 American Association for Cancer Research
2025
American Association for Cancer Research
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