Outcomes of Patients Over 70 Years Treated With Brexu-Cel for R/R Mantle Cell Lymphoma: A Study From the Ctiwp of Ebmt

Mantle cell lymphoma (MCL) predominantly affects older adults, and treatment options for relapsed/refractory (R/R) disease remain limited. Brexucabtagene autoleucel (brexu-cel) has demonstrated high efficacy in R/R MCL, but data in elderly populations are scarce. This retrospective, real‑world analysis evaluated patients aged ≥70 years with R/R MCL treated with brexu‑cel and reported to the EBMT registry between 2020 and 2024. A total of 233 patients from 96 centers across 13 countries were included (median age at infusion, 74.6 years; 44% >75 years). Most had ECOG 0-1 (89%) and were heavily pretreated; 62% had prior BTK inhibitor exposure. At day +100, the best overall response was complete remission in 78% and partial remission in 13%. At 30 days, the cumulative incidence of any-grade cytokine release syndrome (CRS) was 80% (grade ≥3, 9%) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) was 57% (grade ≥3, 22%). At 1 year, overall survival (OS) was 74%, progression-free survival (PFS) 62%, relapse/progression incidence (R-PI) 25%, and non-relapse mortality (NRM) 13%. Patients aged >75 years had outcomes comparable to those aged 70-75 years. In multivariable analysis, ECOG ≥2 remained the strongest predictor of inferior OS (HR 4.50; p<0.001) and PFS (HR 3.10; p<0.001), while age was not independently associated with outcomes. Brexu-cel is effective in patients aged ≥70 years with R/R MCL, achieving high remission rates and meaningful survival, despite relative high incidence of NRM. Functional status, rather than age, should guide eligibility.