Brexucabtagene autoleucel for relapsed/refractory mantle cell lymphoma in asia: redefining the role of allogeneic haematopoietic stem cell transplantation.

Brexucabtagene autoleucel (brexu-cel) is an autologous CD19-directed CAR T-cell therapy approved for relapsed/refractory (R/R) mantle cell lymphoma (MCL) based on the pilot study ZUMA-2. Since then, several US and European real-world studies have demonstrated comparable efficacy outcomes. However, these reports have also suggested potentially higher rates of acute toxicities, particularly immune effector cell-associated neurotoxicity syndrome (ICANS), raising concerns regarding its use, especially in vulnerable populations. At Singapore General Hospital, five patients (median age 75 years) received brexu-cel from April 2025 to Dec 2025 for R/R MCL. Historical cohort MCL patients received allogeneic haematopoietic stem cell transplantation (allo-HSCT) were extracted and compared. For brexu-cel cohort, the overall response rate (ORR) was 100%, with a complete response rate (CRR) of 80%. Cytokine release syndrome (CRS) occurred in 80% of patients, with no grade 3 events, and only one patient developed grade 1 ICANS (20%). These efficacy and safety outcomes compare favourably with historical cohorts of patients who underwent allo-HSCT locally (total 6 patients, 2 relapsed, 2 NRM), despite potentially higher-risk features and less controlled disease at baseline. Efficacy and toxicity of both clinical trial and real-world CAR-T studies for R/R MCL were summarized. To our knowledge, this represents the first real-world report from Asia on brexu-cel in R/R MCL, supporting its use in this region, where published data have thus far predominantly originated from the United States and Europe.