费城染色体阳性急性淋巴细胞白血病患者在 brexucabtagene autoleucel 治疗后，TKI 维持治疗改善了预后结局

Brexucabtagene autoleucel (brexu-cel) produces high rates of measurable residual disease-negative (MRD-) complete response (CR) in adult patients with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL); however, subsequent relapses remain frequent. It is unclear whether maintenance with tyrosine kinase inhibitors (TKIs) can enhance remission durability.

We evaluated outcomes among adult patients with relapsed/refractory Ph+ ALL who received commercial brexu-cel and achieved MRD- CR across 19 US institutions. Considering TKI maintenance as a time-varying covariate, we analyzed outcomes based on receipt of subsequent TKI maintenance vs no maintenance. Patients receiving consolidative transplantation or non-TKI maintenance were excluded. Fifty-one patients were included: 20 received TKI maintenance, and 31 received no maintenance. The use of TKI maintenance was associated with a significantly lower 1-year cumulative incidence of relapse (hazard ratio [HR], 0.

12; 95% confidence interval [CI], 0. 02-0. 88; P = . 037), which translated into improved progression-free survival (PFS; HR, 0. 19; 95% CI, 0. 04-0. 85; P = . 029) and a trend toward improved overall survival (HR, 0. 34; 95% CI, 0. 07-1. 62; P = . 18). There was no difference in nonrelapse mortality (HR, 0. 83; 95% CI, 0. 12-5. 87; P = . 85). This real-world analysis supports the administration of TKI maintenance in Ph+ ALL after achievement of MRD- CR with brexu-cel as a strategy to improve PFS after chimeric antigen receptor T-cell therapy.