CAR T-Cell Therapy Cuts Costs, Reduces Treatment in Mantle Cell Lymphoma

Mantle cell lymphoma (MCL) is a rare form of non-Hodgkin lymphoma, with about 3,300 new cases diagnosed in the U.S. each year. It is typically an aggressive malignancy with a median survival of four to five years. Standard of care treatment includes immunochemotherapy and targeted therapy. Some patients receive stem cell transplantation.

Relapsed or refractory disease is common despite available treatments, and patients inevitably require additional lines of therapy, such as Bruton’s kinase inhibitors. However, even these targeted therapies have been reported to have failure rates of up to 66% in patients with relapsed or refractory MCL.

In 2020, the FDA approved the chimeric antigen receptor T (CAR T)-cell therapy Tecartus (brexucabtagene autoleucel) for treating relapsed or refractory MCL, changing the landscape of MCL treatment. With CAR T-cell therapy, patients’ or donors’ T cells are harvested and modified in a laboratory to target and kill malignant cells. The reengineered cells are then reinfused into the patient.

CAR T-cell therapy comes with a hefty price tag ($373,000 per Tecartus infusion), but cycling through several lines of treatment can also increase costs and healthcare utilization.

Karl M. Kilgore, Ph.D., director of research science and advanced analytics at Inovalon, Inc., and his colleagues conducted an observational study to compare real-world treatment patterns, healthcare resource utilization, and costs between patients receiving CAR T-cell therapy and those treated with non-CAR T standard of care. The study results were published in the March 2025 issue of the Journal of Managed Care and Specialty Pharmacy.

The researchers used Medicare Fee-for-Service data and commercial health insurance data from the Inovalon Medical Outcomes Research for Effectiveness and Economics (MORE) Registry to identify adults diagnosed with MCL from July 1, 2016, through September 30, 2021, for patients with Medicare coverage and July 1, 2016, through September 30, 2022, for commercially insured patients.

Each patient was assigned to a cohort based on whether they received CAR T-cell therapy (Tecartus). The patients in the non-CAR T group did not receive CAR T-cell therapy at any time during the study period, which was January 1, 2016, to December 31, 2021, for Medicare claims and January 1, 2016, to June 30, 2023, for patients with commercial insurance. Those stratified to the CAR T group received CAR T-cell therapy any time after diagnosis and after Tecartus FDA approval.

A total of 2,835 patients were included in the non-CAR T cohort and 122 in the CAR T-cell therapy cohort. The study results showed that patients who received CAR T-cell therapy had a longer time to next treatment compared with participants in the non-CAR T group. Additionally, patients who did not receive CAR T-cell therapy were more likely to receive three or more lines of therapy, with time to next treatment decreasing with each line of treatment.

Only 15% of patients in the CAR T group required an additional line of treatment compared with 37% of patients in the non-CAR T cohort who received at least three additional lines of treatment. After receiving CAR T-cell therapy, 91% of patients needed no further targeted treatment. In contrast, 76% of patients in the non-CAR T group required targeted therapy after two lines of treatment, and the percentage increased progressively with each line of therapy.

Inpatient and emergency department visits were higher in the non-CAR T versus the CAR T group, but the differences were not statistically significant. However, MCL-related medical and pharmacy costs were significantly lower for the CAR T cohort compared with the non-CAR T group, excluding the cost of CAR T-cell therapy administration.

The authors emphasized that their findings indicate CAR T-cell therapy could reduce or prevent the patient burdens and healthcare costs associated with cycling through non-CAR T-cell therapy standard treatments in patients with relapsed or refractory MCL. However, they recommend further research to assess long-term outcomes of CAR T-cell therapy and evaluate cost-effectiveness that includes direct infusion costs.