Feasibility of CAR-T in very old patients with relapsed/refractory diffuse large B-cell lymphoma.
Year: 2023
Type: conference-abstract
Abstract: e19521 Background: Chimeric antigen receptor T-cell therapy (CAR-T) has shown great efficacy in older relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) patients (pts). Pivotal trials have shown similar progression free survival (PFS) and overall survival (OS) between older and younger pts, and no difference in the incidence of cytokine release syndrome (CRS), immune effector cell associated neurotoxicity syndrome (ICANS), or grade 3-4 hematologic and non-hematologic toxicities. Nevertheless, there are limited reports in the literature concerning very old pts (≥75 years) receiving CAR-T for R/R DLBCL, and especially real world data in correlation with co-morbidities. Methods: We conducted a retrospective, single center analysis, including R/R DLBCL pts who underwent apheresis for CAR-T at 75 and older. We assessed co-morbidities by Cumulative Illness Rating Scale (CIRS-G) tool which set a score of 0-4 on all organ systems according to severity, and polypharmacy at time of apheresis, defined as ≥5 medications per day. We analyzed baseline characteristics, response rates, toxicity, and survival outcomes (PFS and OS). Results: A total of 47 pts were referred for CAR-T treatment. Median age at apheresis was 76.6 (75-86) years. Most of these pts received first-line treatment with full or attenuated dose R-CHOP (89%). However, 20 pts (42.5%) had refractory disease, and those achieving PR/CR had a median time to relapse of 13 months. Thirty-two pts (68%) were referred for CAR-T with refractory disease. Six pts died before receiving the CAR-T infusion due to PD. Characteristics of 41 pts receiving CAR-T infusion divided into subgroups of pts with CIRS-G categories 3-4 and pts with polypharmacy are shown in the table. Conclusions: CAR-T in very old (≥ 75 years) R/R DLBCL is feasible with no increased toxicity. While efficacy is important, the preliminary survival analysis seems suboptimal. At 1-year follow-up only a third of pts are alive. Severe co-morbidities or polypharmacy did not impact response or survival. Most deaths were due to disease progression, these outcomes might be attributed to the high rate of refractory disease. [Table: see text]
Source: Journal of Clinical Oncology
Institution: Moffitt Cancer Center
Language: English
Topic: CAR-T cell therapy research
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4379345402