(309) Systematic Literature Review of Healthcare Resource Use (HCRU), Costs and Health-Related Quality of Life (HRQoL) for Brexucabtagene autoleucel in Relapsed/Refractory (R/R) Mantle Cell Lymphoma (MCL) and Precursor B-cell lymphoblastic leukemia (B-ALL)

Background: : Brexucabtagene autoleucel (brexu-cel) is an autologous CD19-directed chimeric antigen receptor (CAR) T-cell therapy approved and highly effective for the treatment of adults with R/R MCL and R/R B-ALL. Demonstrating its full value requires a comprehensive understanding of its HCRU, costs and HRQoL impact in trials and the real-world (RW).

Objective: : To systematically identify and summarize evidence on HCRU, costs and HRQoL associated with brexu-cel treatment in adult patients with R/R MCL and B-ALL.

Methods: : A systematic literature review (SLR) was conducted per PRISMA guidelines, using Embase, Medline, and CENTRAL (2020–2024; search on Dec 16, 2024), and hand searches of pre-selected conferences. Studies were selected using separate PICOS frameworks for HCRU, costs and HRQoL. Real-world evidence (RWE) was eligible for all outcomes, and clinical trials were eligible for HRQoL only. All steps were performed in duplicate, and data were synthesized descriptively.

Results: : Through the systematic searches, we identified 31 publications on HCRU and/or costs from 19 unique RW cohorts and 5 HRQoL publications from 2 trials (ZUMA-2 in R/R MCL and ZUMA-3 in R/R B-ALL). Most HCRU and costs cohorts focused on MCL (n=13), with fewer on B-ALL (n=4) or both (n=2). Studies were conducted in the US and Europe. Hospital length of stay ranged 15–22 days, and was generally longer in MCL. ICU admission rates varied, being higher in MCL (11–34%) than in B-ALL (0–20%). RW costs were reported for one US MCL cohort, with post-infusion per-patient-per-month costs of $9,096 (Medicare) and $4,822 (commercial), 24% and 70% lower costs vs non–CAR T patients, respectively. HRQoL was assessed using EQ-5D-5L/EQ-5D-VAS, and improved over time in both ZUMA-2 and ZUMA-3. Patients treated with brexu-cel experienced transient decline post-infusion (month 1), followed by a recovery to baseline or improvement from month 3 onward for some EQ-5D-5L functional domains (mobility, self-care and usual activity). For symptoms domains (anxiety/depression and pain/discomfort) the trends suggested stability over the same period.

Conclusions: : This SLR found brexu-cel to be associated with notable reduction in post-infusion hospitalization and ICU use, as well as lower post-infusion costs compared to non-CAR T patients. In trial settings, brexu-cel was also associated with HRQoL improvements in patients with R/R MCL and R/R B-ALL. More RWE is needed to evaluate HRQoL, capture a broader range of HCRU and cost outcomes, and support future value assessments of brexu-cel in clinical and policy decision-making.

Sponsorship:: Kite Pharma