Brexucabtagene autoleucel consolidation in adult B-cell acute lymphoblastic leukemia: real-world efficacy and toxicity

Nitin Jain; Niranjan Khaire; Nicholas Short; Shilpa Paul; Alexandra Lovell; Jayastu Senapati; Hannah Goulart; Gautam Borthakur; Tapan Kadia; Koichi Takahashi; Naveen Pemmaraju; Naval Daver; Ghayas Issa; Musa Yilmaz; Fadi G. Haddad; Wei-Ying Jen; Rabiul Islam; Rebecca Garris; Sa Wang; Beenu Thakral; Partow Kebriaei; Bouthaina Dabaja; Elizabeth Shpall; Sattva Neelapu; William Wierda; Guillermo Garcia-Manero; Farhad Ravandi; Hagop Kantarjian; Elias Jabbour

doi:10.1016/j.bict.2026.100059

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Brexucabtagene autoleucel consolidation in adult B-cell acute lymphoblastic leukemia: real-world efficacy and toxicity

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Brexucabtagene autoleucel consolidation in adult B-cell acute lymphoblastic leukemia: real-world efficacy and toxicity

Nitin Jain, Niranjan Khaire, Nicholas Short, Shilpa Paul, Alexandra Lovell, Jayastu Senapati, Hannah Goulart, Gautam Borthakur, Tapan Kadia, Koichi Takahashi, …

Blood immunology & cellular therapy, Vol.2(2), 100059

06/09/2026

DOI: 10.1016/j.bict.2026.100059

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Abstract

•Brexu-cel in patients with <5% marrow blasts is associated with low rates of grades 3-4 CRS/ICANS.•CAR T-cell expansion was noted even in patients with no detectable disease, and higher CAR T-cell expansion had lower likelihood of relapse. [Display omitted] Brexucabtagene autoleucel (brexu-cel), a CD19 chimeric antigen receptor (CAR) T cell is approved for patients with relapsed/refractory B-cell acute lymphoblastic leukemia. In the pivotal ZUMA-3 trial, patients were required to have >5% marrow blasts. We aimed to evaluate efficacy/toxicity with brexu-cel in a real-world setting with marrow blasts of <5%. CAR T-cell levels were assessed in the peripheral blood using flow cytometry. A total of 52 patients were included. The median age was 36.5 years. Patients received a median of 2 previous lines of therapy. At the time of infusion, 14 of 52 patients had next-generation sequencing (NGS) measurable residual disease (MRD)–positive disease; the remaining 38 patients were in NGS MRD–negative remission. The median peak CAR T-cell expansion was 11.5 cells per μL at a median of 8 days after infusion. A peak CAR T-cell expansion threshold of 15 cells per μL was identified as optimal predictor for outcomes. A total of 25 of 52 (48%) patients had a peak CAR T-cell expansion of ≥15 cells per μL and only 4 of 25 (16%) experienced relapse; conversely, 13 of 27 (48%) patients had a relapse among those with peak expansion of <15 cells per μL. With a median follow-up of 24.3 months, 24-month relapse-free survival and overall survival was 59% and 78%, respectively. Grade 3 cytokine release syndrome (CRS) occurred in 1 (2%) patient; grades 3-4 immune effector cell–associated neurotoxicity syndrome (ICANS) occurred in 5 (10%) patients. This study highlights CAR T-cell expansion in patients with no morphologic disease, including among patients with NGS-negative remission, and this approach is associated with low rates of grades 3-4 CRS/ICANS.

Details

Title: Subtitle: Brexucabtagene autoleucel consolidation in adult B-cell acute lymphoblastic leukemia: real-world efficacy and toxicity
Creators: Nitin Jain - The University of Texas MD Anderson Cancer Center
Niranjan Khaire - The University of Texas MD Anderson Cancer Center
Nicholas Short - The University of Texas MD Anderson Cancer Center
Shilpa Paul - The University of Texas MD Anderson Cancer Center
Alexandra Lovell - The University of Texas MD Anderson Cancer Center
Jayastu Senapati - The University of Texas MD Anderson Cancer Center
Hannah Goulart - The University of Texas MD Anderson Cancer Center
Gautam Borthakur - The University of Texas MD Anderson Cancer Center
Tapan Kadia - The University of Texas MD Anderson Cancer Center
Koichi Takahashi - The University of Texas MD Anderson Cancer Center
Naveen Pemmaraju - The University of Texas MD Anderson Cancer Center
Naval Daver - The University of Texas MD Anderson Cancer Center
Ghayas Issa - The University of Texas MD Anderson Cancer Center
Musa Yilmaz - The University of Texas MD Anderson Cancer Center
Fadi G. Haddad - The University of Texas MD Anderson Cancer Center
Wei-Ying Jen - The University of Texas MD Anderson Cancer Center
Rabiul Islam - The University of Texas MD Anderson Cancer Center
Rebecca Garris - The University of Texas MD Anderson Cancer Center
Sa Wang - The University of Texas MD Anderson Cancer Center
Beenu Thakral - The University of Texas MD Anderson Cancer Center
Partow Kebriaei - The University of Texas MD Anderson Cancer Center
Bouthaina Dabaja - The University of Texas MD Anderson Cancer Center
Elizabeth Shpall - The University of Texas MD Anderson Cancer Center
Sattva Neelapu - The University of Texas MD Anderson Cancer Center
William Wierda - The University of Texas MD Anderson Cancer Center
Guillermo Garcia-Manero - The University of Texas MD Anderson Cancer Center
Farhad Ravandi - The University of Texas MD Anderson Cancer Center
Hagop Kantarjian - The University of Texas MD Anderson Cancer Center
Elias Jabbour - The University of Texas MD Anderson Cancer Center
Resource Type: Journal article
Publication Details: Blood immunology & cellular therapy, Vol.2(2), 100059
DOI: 10.1016/j.bict.2026.100059
ISSN: 3050-5976
eISSN: 3050-5976
Publisher: Elsevier Inc
Language: English
Date published: 06/09/2026
Academic Unit: Internal Medicine
Record Identifier: 9985240981902771

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