Abstract
Real World Outcomes of CAR T-Cell Therapy for B-Cell Lymphoma in Adults Age ≥ 65: A Referral Center Experience
Transplantation and cellular therapy, Vol.31(2 Supplement), pp.S241-S241
02/2025
DOI: 10.1016/j.jtct.2025.01.367
Abstract
Treatment options for relapsed/refractory (R/R) B-cell lymphoma have greatly expanded since the introduction of chimeric antigen receptor T (CAR T) cell therapies. Initially, CAR T was not widely applicable to elderly patients due to concern for potentially life-threatening toxicity, especially cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity (ICANS), and infectious complications secondary to prolonged B-cell suppression. Over time, with increased understanding of the pathophysiology of CRS/ICANS and appropriate supportive care, age alone no longer prohibits the use of CAR T.
We reviewed medical records of patients diagnosed with R/R Diffuse large B-cell lymphoma (DLBCL)/High-grade B-cell lymphoma (HGBL) and Mantle cell lymphoma (MCL) age ≥ 65 treated at our center between 2018-2024.
Among the 61 patients, 49 had DLBCL/HGBL and 12 had MCL; the median age was 72 years old (range 65-84) and 38 patients were male. Median prior lines of therapy were 2 (range 1-11) including 9 prior autologous transplants. The pre-CAR T Karnofsky performance score (KPS) was 90 - 100 in 26 patients and ≤ 80 for 35 patients. CAR T products included: 36 Axicel, 12 Brexucel, 10 Lisocel, and 3 Tisacel.
Best overall response was complete remission in 32 patients (52.5%), partial response in 17 patients (27.9%), stable disease in 3 patients (4.9%), progressive disease in 8 patients (13.1%), and 1 unable to assess (1.6%). Median time to best response was 40 days. When stratified by diagnosis, there was no statistical difference in relapse-free survival (RFS) (HR: 0.82, 95% CI 0.36-1.87, p=0.63) or overall survival (OS) (HR: 0.80, 95% CI 0.31-2.09, p=0.65) between MCL vs DLBCL/HGBL. There was also no significant difference in RFS and OS among patients age 65-70 vs those age ≥ 70. However, on univariate analysis, KPS ≤ 80 was associated with inferior RFS (HR 4.63, 95% CI 2.09 – 10.25, p<0.01) and OS (HR 4.41, 95% CI 1.87 – 10.42, p<0.01).
For toxicity profile, maximum CRS was grade 0-1 in 42 patients (68.9%), grade 2 in 17 patients (27.9%), and grade 3 in 2 patients (3.3%); maximum ICANS was grade 0-1 in 32 patients (52.5%), grade 2 in 16 patients (26.2%), grade 3 in 11 patients (18.0%), and grade 4 in 2 patients (3.3%). There were 35 infectious complication events including C. difficile diarrhea (N=11, all grade 2), viral upper respiratory infection (N=8, all grade 2), CMV viremia (N=5, grade 2; N=3, grade 3), bacteremia (N=6, all grade 2), and fungal pneumonia (N=2, both grade 3). Median length of hospital stay was 21 days (range 13-91). Five patients died during CAR T cell admission from progressive lymphoma.
Our real-world experience illustrates that CAR T can be a useful treatment option for elderly patients, especially in those with optimal functional status. The side effects profile was manageable, granting many patients a chance of durable remission.
Details
- Title: Subtitle
- Real World Outcomes of CAR T-Cell Therapy for B-Cell Lymphoma in Adults Age ≥ 65: A Referral Center Experience
- Creators
- Andrew Vegel - University of IowaSarah Mott - University of IowaJames McCollough - University of IowaHira Shaikh - University of IowaChristopher Strouse - University of IowaUmar Farooq - University of IowaMargarida Magalhaes-Silverman - University of IowaKittika Poonsombudlert - University of Iowa
- Resource Type
- Abstract
- Publication Details
- Transplantation and cellular therapy, Vol.31(2 Supplement), pp.S241-S241
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jtct.2025.01.367
- ISSN
- 2666-6367
- eISSN
- 2666-6367
- Language
- English
- Date published
- 02/2025
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine; Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984793878502771
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