TKI maintenance following brexu-cel therapy in R/R Ph+ B-ALL

Results from a retrospective analysis using data from the Real-World Outcomes Collaborative for CAR T in ALL (ROCCA) consortium database were published in Blood Advances by Othman et al. The study evaluated tyrosine kinase inhibitor (TKI) maintenance in 51 adults with relapsed/refractory (R/R) Philadelphia chromosome-positive (Ph+) B-cell acute lymphoblastic leukemia (B-ALL) who achieved measurable residual disease (MRD)-negative complete response (CR) following brexucabtagene autoleucel (brexu-cel) therapy. The primary endpoint was progression-free survival (PFS).

Key data: TKI maintenance (n = 20) vs no maintenance (n = 31) was associated with a higher estimated 1-year PFS rate (91% vs 62%; hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.04–0.85; p = 0.029) and a lower 1-year cumulative incidence of relapse (5% vs 32%; HR, 0.12; 95% CI, 0.02–0.88; p = 0.037). The estimated 1-year overall survival (OS; 96% vs 88%; p = 0.18) and non-relapse mortality (NRM; 5% vs 6%; p = 0.85) rates were similar between the TKI maintenance and no maintenance groups.

Key learning: Among adults with R/R Ph+ B-ALL achieving MRD-negative CR after brexu-cel therapy, TKI maintenance was associated with improved 1-year PFS and reduced relapse rates compared with no maintenance, supporting prospective validation as a post-remission consolidation strategy.