Is Age Just A Number? Analyzing CAR T-cell Therapy for B-cell Lymphoma

A multi-center cancer study reveals age should not be a limiting factor when considering CAR T-cell therapy for B-cell lymphoma patients. 

The purpose of this study was to evaluate the outcomes and safety profile of CAR T-cell therapy in patients 80 years and older with B-cell lymphomas.

During the 2024 European Hematology Association (EHA) Conference, Dr. Julio Chavez from Moffitt Cancer Center in Florida shared the group’s findings after examining data from 16 cancer centers across the nation. 

Study Details 

The research team collected data from 16 academic centers across the United States. 

The study included B-cell lymphoma patients who received CAR T-cell therapy as the standard of care. 

The data points analyzed included (but were not limited to) overall response rate (ORR) and complete response (CR), survival outcomes, and toxicity. 

The study included 88 patients aged 80 to 89, with a median age of 82. The majority of these patients were male (73.9%). 

Study Results 

Infusion Details 

Most patients (87.5%) received their CAR T-cell therapy in an inpatient setting, spending an average of 14 days in the hospital for this procedure. Twenty-one patients (23.9%) required readmission to the hospital within the first 100 days post CAR T. 

The most commonly prescribed CAR T-cell therapy product was axicabtagene ciloleucel (Yescarta, Kite.)

Side Effect Results 

Cytokine release syndrome (CRS) is a common yet serious side effect that can lead to infections, fevers, and organ damage. It is classified by grades (1-4), with the lower grades being easily manageable and the higher grades being more serious and may require time in the intensive care unit (ICU). 

In this study: 

• CRS of any grade was reported in 68 patients (77.3%)
• The median time to onset (recognizable symptoms) was 3 days 
• 5 of the 68 patients developed serious CRS (grades 3-4)

ICANS is a neurological side effect that can affect brain function and cognitive awareness. 

In this study: 

• 51 of 88 patients (58%) developed ICANS 
• Symptoms appeared at a median of 6 days 
• These symptoms lasted a median of 6 days 

These side effect results were comparable to younger patients receiving CAR T-cell therapy. 

Response Results 

60 patients achieved a complete response as a result of e CAR T-cell therapy, which took a median of 38 days. 

A subanalysis shown below presents response rates for DLBCL/transformed follicular lymphoma and mantle cell lymphoma patients. 

The following results were observed 12 months after the CAR T-cell infusion. 

For DLBCL/transformed follicular lymphoma patients: 

• Progression-free survival (PFS) was 46.3%
• Overall survival was 61.2%

For mantle cell lymphoma patients: 

• Progression-free survival (PFS) was 40%
• Overall survival was 38.9%

These response results were comparable to younger patients receiving CAR T-cell therapy. 

Conclusion

This multicenter study shows that even those 80 and older can successfully receive CAR T-cell therapy for B-cell lymphoma treatment. The study revealed that older individuals have comparable outcomes to their younger counterparts, meaning age alone should not disqualify a patient from what could be a life-saving procedure. 

Dr. Chavez and his research team hope their findings will inform clinical decision-making surrounding CAR T-cell therapy candidates and avoid age bias of not offering CAR T-cell therapies to patients who could be candidates for this treatment. 

These results are a great example of how clinical trials can help change how doctors practice and open the doors for lifesaving therapies to be given to new groups of people. If you want to participate in a clinical trial, find one that’s right for you today.

B-cell Lymphoma Clinical Trials

Sources: 

• CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY IS FEASIBLE IN PATIENTS 80 YEARS OF AGE OR OLDER WITH B-CELL LYMPHOMA: A US MULTICENTER COLLABORATIVE STUDY
• CAR-T Therapy Feasibility in Patients ≥80 with B-Cell Lymphoma | Julio Chavez, MD | EHA 2024