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In this prospective, observational multicentre study, we evaluated 106 patients, with longitudinal brexu\u2010cel kinetics in peripheral blood monitored in 61 of them. Clinical outcomes and toxicities are consistent with previous real\u2010world evidence studies. Notably, beyond established poor prognostic factors\u2014such as blastoid variant and elevated lactate dehydrogenase\u2014Bruton tyrosine\u2010kinase inhibitors (BTKi) refractoriness and platelet count emerged as significant predictors of survival. Specifically, the 1\u2010year overall survival was 56% in BTKi\u2010refractory patients compared to 92% in BTKi\u2010relapsed patients (<jats:italic>p<\/jats:italic>\u2009=\u20090.0001). Our study also demonstrated that in\u2010vivo monitoring of brexu\u2010cel expansion is feasible and correlates with progression\u2010free survival and toxicities. Progression\u2010free survival at 1\u2009year was 74% in patients categorized as strong expanders, based on brexu\u2010cel peak concentration, versus 54% in poor expanders (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). Furthermore, in\u2010vivo expansion helped identify a high\u2010risk group of non\u2010responders, those with progressive or stable disease at the 90\u2010day post\u2010infusion evaluation (OR\u2009=\u20094.7, 95% CI\u2009=\u20091.1\u201334, <jats:italic>p<\/jats:italic>\u2009=\u20090.04) characterized by dismal outcomes. When integrated with other clinical factors, monitoring brexu\u2010cel expansion could assist in recognizing patients at high risk of early relapse.<\/jats:p>","DOI":"10.1111\/bjh.19961","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T06:09:38Z","timestamp":1734934178000},"page":"644-651","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Brexucabtagene autoleucel in\u2010vivo expansion and <scp>BTKi<\/scp> refractoriness have a negative influence on progression\u2010free survival in mantle cell lymphoma: Results from <scp>CART<\/scp>\u2010<scp>SIE<\/scp> study"],"prefix":"10.1111","volume":"206","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3401-1309","authenticated-orcid":false,"given":"Federico","family":"Stella","sequence":"first","affiliation":[{"name":"Hematology, School of Medicine Universit\u00e0 degli Studi di Milano  Milan Italy"},{"name":"Division of Hematology Fondazione IRCCS Istituto Nazionale dei Tumori  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2977-0098","authenticated-orcid":false,"given":"Annalisa","family":"Chiappella","sequence":"additional","affiliation":[{"name":"Division of Hematology Fondazione IRCCS Istituto Nazionale dei Tumori  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9458-5836","authenticated-orcid":false,"given":"Martina","family":"Magni","sequence":"additional","affiliation":[{"name":"Division of Hematology Fondazione IRCCS Istituto Nazionale dei Tumori  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1544-9911","authenticated-orcid":false,"given":"Francesca","family":"Bonifazi","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna, Istituto di Ematologia \u201cSer\u00e0gnoli\u201d  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"De Philippis","sequence":"additional","affiliation":[{"name":"Department of Oncology\/Hematology IRCCS Humanitas Research Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Musso","sequence":"additional","affiliation":[{"name":"Dipartimento Oncologico \u201cLa Maddalena\u201d UOC di Oncoematologia e TMO  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3721-0004","authenticated-orcid":false,"given":"Ilaria","family":"Cutini","sequence":"additional","affiliation":[{"name":"SOD Terapie Cellulari e Medicina Trasfusionale, AAD Trapianto di midollo osseo Ospedale Careggi  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silva","family":"Ljevar","sequence":"additional","affiliation":[{"name":"Department of Data Science, Unit of Biostatistics for Clinical Research Fondazione IRCCS Istituto Nazionale dei Tumori  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Barbui","sequence":"additional","affiliation":[{"name":"Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Farina","sequence":"additional","affiliation":[{"name":"Unit of Blood Disease and Bone Marrow Transplantation, Unit of Hematology University of Brescia, ASST Spedali Civili di Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Martino","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplantation and Cellular Therapies Unit (CTMO), Department of Hemato\u2010Oncology and Radiotherapy Grande Ospedale Metropolitano \u201cBianchi\u2010Melacrino\u2010Morelli\u201d  Reggio Calabria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Massaia","sequence":"additional","affiliation":[{"name":"Division of Hematology\u2014AO S. 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