[Efficacy and toxicity of brexucabtagene autoleucel in the treatment of high-risk mantle cell lymphoma: description of a clinical case].

Abstract

Introduction: Relapsed or refractory (R/R) mantle cell lymphoma (MCL) represent a setting at unfavourable prognosis. Chimeric antigen receptor T-cells (CAR-T) are recently introduced in clinical practice as a new therapeutic option for this setting.

Clinical case: 61-year-old man with MCL pleomorphic variant, TP53 mutated with high risk MIPI-c early relapsed after frontline immunochemotherapy and ibrutinib. It has treated with brexucabtagene autoleucel (brexu-cel) as third line. A complete remission (CR) is obtained at 1 moth post infusion but the patient developed a severe and prolonged hematological toxicity: anemia G4, thrombocytopenia G4, neutropenia G4. Three months post-CAR-T infusion eltrombopag is introduced with rapid hemoglobin and platelet count recovery and an improvement in neutrophil count but persistent G3 neutropenia at 2 years of follow up. The bone marrow biopsy revealed a granulocytic hypoplasia with a clonal hemopoiesis (ASLX1 and DNMT3A mutations encountered) at the next generation sequencing test (NGS). The patient is in persistent CR at 2 years post brexu-cel infusion without major infection encountered.

Conclusions: Brexu-cel represents an effective treatment option even in R/R MCL with high-risk features but can be associated with prolonged toxicities. An accurate patient selection and a close monitoring during post-CAR-T follow-up is crucial in order to prolong survival of these patients.