Affiliation:
1. Division of Hematologic Malignancies and Cellular Therapeutics The University of Kansas Kansas City Kansas USA
2. Department of Lymphoma and Myeloma The University of Texas MD Anderson Cancer Center Houston Texas USA
3. Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center Northwestern University Chicago Illinois USA
4. Division of Hematology Mayo Clinic Rochester Minnesota USA
5. Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine University of Wisconsin Carbone Cancer Center Madison Wisconsin USA
6. Division of Hematology & Oncology Medical College of Wisconsin Milwaukee Wisconsin USA
7. Division of Hematology/Oncology Mayo Clinic Arizona Scottsdale Arizona USA
Abstract
AbstractChimeric antigen receptor T‐cell (CAR‐T) therapy, despite being a potentially curative therapy in relapsed or refractory (RR) large B‐cell lymphoma (LBCL), remains underutilized in older patients due to limited clinical data. We therefore studied the safety and efficacy of CAR‐T therapy in older patients with RR LBCL in the real‐world setting. Patients aged ≥65 years with RR LBCL, treated with anti‐CD19 CAR‐T therapy at 7 US institutions were included in this multicenter, retrospective, observational study. In total, 226 patients were included. Median age at infusion was 71 years (range 65–89). Best objective and complete response rates were 86% and 62%, respectively. Median follow‐up after infusion was 18.3 months. The median progression‐free survival (PFS) was 6.9 months, with 6‐ and 12‐month PFS estimates of 54% and 44%, respectively. The nonrelapse mortality (NRM) rate was 10.9% at day 180, primarily due to infections, and not impacted by the age groups. Grade ≥3 cytokine release syndrome and neurotoxicity occurred in 7% and 26%, respectively. In univariate analysis, no significant difference in PFS was seen regardless of the age groups or CAR‐T type, whereas ECOG PS ≥2, elevated LDH, bulky disease, advanced stage, extranodal involvement, the need for bridging therapy, and prior bendamustine exposure were associated with shorter PFS. These findings support the use of CAR‐T in older patients, including those aged ≥80 years. The age at CAR‐T therapy did not influence safety, survival, and NRM outcomes. Older patients should not be excluded from receiving CAR‐T therapy solely based on their chronological age.