Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the impact on patients of withdrawing access to an existing cancer treatment, namely CAR-T therapy for relapsed or refractory mantle cell lymphoma, which has been available on the NHS since 2021.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

202 patients have received brexucabtagene autoleucel, a form of CAR-T therapy, for the treatment of mantle cell lymphoma via the Cancer Drugs Fund (CDF). This data is taken from NHS England’s prior approval system. The National Institute for Health and Care Excellence (NICE) is currently re-evaluating the evidence on clinical outcomes collected through its use in the CDF in its ongoing re-evaluation of brexucabtagene autoleucel.

NICE published final draft guidance on 24 December 2025 in which it was not able to recommend brexucabtagene autoleucel for the treatment of relapsed or refractory mantle cell lymphoma in adults who have had two or more lines of systemic treatment that included a Bruton's tyrosine kinase inhibitor. This is because the extent of brexucabtagene autoleucel’s clinical benefit is uncertain. There are also uncertainties in the economic model because there is not enough evidence to tell if the cancer can be ‘cured’ in people having brexucabtagene autoleucel and it is not known how long people live after having brexucabtagene autoleucel. The cost-effectiveness estimates are also substantially above the range that NICE considers an acceptable use of National Health Service resources. NICE has not yet published final guidance and stakeholders have recently had an opportunity to appeal NICE’s recommendations.

The Government recognises that the potential withdrawal of brexucabtagene autoleucel as a treatment for future patients will be concerning for patients and their families, but it is right that these decisions are taken independently and on the basis of the available evidence. In line with an arrangement between NHS England and the company, if NICE’s final guidance does not recommend use, patients who started treatment during the managed access period can continue their treatment.

Question to the Department of Health and Social Care:

To ask His Majesty's Government how many patients have received CAR-T therapy for mantle cell lymphoma via the Cancer Drugs Fund; and what assessment has been made of the clinical outcomes for those patients.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

202 patients have received brexucabtagene autoleucel, a form of CAR-T therapy, for the treatment of mantle cell lymphoma via the Cancer Drugs Fund (CDF). This data is taken from NHS England’s prior approval system. The National Institute for Health and Care Excellence (NICE) is currently re-evaluating the evidence on clinical outcomes collected through its use in the CDF in its ongoing re-evaluation of brexucabtagene autoleucel.

NICE published final draft guidance on 24 December 2025 in which it was not able to recommend brexucabtagene autoleucel for the treatment of relapsed or refractory mantle cell lymphoma in adults who have had two or more lines of systemic treatment that included a Bruton's tyrosine kinase inhibitor. This is because the extent of brexucabtagene autoleucel’s clinical benefit is uncertain. There are also uncertainties in the economic model because there is not enough evidence to tell if the cancer can be ‘cured’ in people having brexucabtagene autoleucel and it is not known how long people live after having brexucabtagene autoleucel. The cost-effectiveness estimates are also substantially above the range that NICE considers an acceptable use of National Health Service resources. NICE has not yet published final guidance and stakeholders have recently had an opportunity to appeal NICE’s recommendations.

The Government recognises that the potential withdrawal of brexucabtagene autoleucel as a treatment for future patients will be concerning for patients and their families, but it is right that these decisions are taken independently and on the basis of the available evidence. In line with an arrangement between NHS England and the company, if NICE’s final guidance does not recommend use, patients who started treatment during the managed access period can continue their treatment.

Question to the Department for Transport:

To ask His Majesty's Government what assessment they have made of the availability of specialist rail plant used in the maintenance of the rail network.

Answered by Lord Hendy of Richmond Hill - Minister of State (Department for Transport)

Network Rail is responsible for assessing the availability of specialist rail plant used in maintaining the rail network. It is currently reviewing its long-term equipment requirements for track maintenance and renewals, to ensure that it has the capacity, flexibility, and technology it needs to meet future demand efficiently.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what safeguards exist to prevent patients from losing access to established, life-extending cancer treatments as a result of changes to NICE methodology.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

The National Institute for Health and Care Excellence (NICE) evaluates all newly licensed cancer medicines and may recommend promising treatments for use through the Cancer Drugs Fund (CDF) where there is too much clinical uncertainty for routine commissioning. Under these arrangements, cancer medicines are made available to National Health Service patients for a defined period while further real‑world evidence is collected to address the uncertainties identified in NICE’s original appraisal.

At the end of the managed access period, NICE undertakes a full re‑appraisal of the medicine. This re‑appraisal considers all the evidence gathered during CDF use alongside updated clinical and cost‑effectiveness analyses. NICE then determines whether the medicine should be routinely funded by the NHS, or whether it cannot be recommended for routine commissioning. This re‑appraisal process is one of the limited circumstances in which NICE routinely re‑evaluates previous decisions.

In 2022, NICE updated its methods and replaced the earlier end‑of‑life flexibilities with the severity modifier. As a result, re‑appraisals of cancer medicines that originally entered the CDF under end‑of‑life criteria are now conducted in line with NICE’s current methods framework, ensuring consistency, fairness, and opportunity‑cost neutrality across all appraisals. NICE has recommended 96% of the medicines that it has re-appraised following a period of managed access for routine NHS use. Where NICE is unable to recommend a medicine for routine use following the period of managed access, it remains available for existing patients but is no longer routinely funded for new patients.

Question to the Department of Health and Social Care:

To ask His Majesty's Government what treatments exist for those mantle cell lymphoma patients unable to access allogeneic stem cell transplants due to (1) ethnicity, (2) age, and (3) ethnicity and age.

Answered by Baroness Merron - Parliamentary Under-Secretary (Department of Health and Social Care)

A number of National Health Service treatment options are available for patients with mantle cell lymphoma, and may include:

- chemotherapy plus rituximab;

- autologous stem cell transplant;

- ibrutinib;

- zanubrutinib;

- brexucabtagene autoleucel, a type of chimeric antigen receptor T-cell therapy; and/or

- supportive care.

None of these treatments are precluded on the basis of ethnicity, age, or a combination of the two, but available options will be dependent on individual clinical circumstances and any prior treatment or treatments received.

Potential treatment options are also currently being appraised by the National Institute for Health and Care Excellence and therefore could be made available within England in the future, subject to positive recommendations on NHS adoption being reached. These are: Acalabrutinib with bendamustine and rituximab; and Ibrutinib with R-CHOP.