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With a median age of 68 years, older patients make up the majority of diffuse large B-cell lymphoma (DLBCL) cases; however, data regarding the efficacy and safety of novel therapies in this population are limited. Therefore, the Lymphoma Hub is presenting an educational theme series on the treatment of older patients with lymphoma. Previously, the Lymphoma Hub published a summary of the results from the ZUMA-1 trial, which found that older patients with advanced B-cell non-Hodgkin lymphoma responded well to chimeric antigen receptor (CAR) T-cell therapy, similar to younger patients; the summary article can be found here.
At the 2021 Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR, Ron Ram presented findings from a multicenter cohort study comparing the efficacy and safety of CAR T-cell therapy in older and younger patients with DLBCL.1
Table 1. Baseline characteristics of both cohorts*
|
Cohort |
Matched control |
p value |
---|---|---|---|
Mean age, years (± SD) |
76.2 (4.4) |
55.4 (15) |
<0.001 |
Sex, n (%) |
|
|
|
Therapy, n (%) |
|
|
0.78 |
ECOG performance status, n (%) |
|
|
0.19 |
Specific comorbidities, n (%) |
|
|
|
Lines prior to CAR-T, n (%) |
|
|
0.45 |
High LDH prior to CAR-T, n (%) |
18 (43.9) |
18 (43.9) |
1.0 |
CAR-T, chimeric antigen receptor T-cell therapy; ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; SD, standard deviation. |
Table 2. Safety of CAR T-cell therapy in both cohorts*
|
Cohort |
Matched control |
p value |
---|---|---|---|
CRS, n (%) |
|
|
0.88 |
ICANS, n (%) |
|
|
0.48 |
Tocilizumab, doses/patient |
1.5 |
0.9 |
0.48 |
Patient given steroids, n (%) |
14 (32.5) |
10 (24.4) |
0.26 |
Need for GCSF on Day 14, n (%) |
9 (22) |
15 (36.9) |
0.11 |
Early infections, n (%) |
|
|
0.30 |
Organ dysfunction, n (%) |
|
|
1.0 |
Days of hospitalization, mean (± SD) |
23.4 (8) |
24.6 (9.6) |
0.55 |
Late pancytopenia, n (%) |
9 (22) |
11 (26.8) |
0.39 |
IgG levels <4 gr/L, n (%) |
5 (23.8) |
5 (33) |
0.39 |
Reactivation of CMV, n (%) |
6 (18.8) |
5 (15.2) |
0.23 |
Reactivation of HHV-6, n (%) |
3 (15) |
1 (4.3) |
0.09 |
CDI, clinically documented infection; CMV, cytomegalovirus; CRS, cytokine release syndrome; GCSF, granulocyte colony-stimulating factor; HHV-6, human herpesvirus-6; IgG, immunoglobulin G; ICANS, immune effector cell-associated neurotoxicity syndrome; MDI, microbiologically documented infection; SD, standard deviation. |
Overall, this study demonstrated that CAR T-cell therapy induces response rates in older patients that are similar to those in younger patients, while it also showed a favorable safety profile. This suggests that CAR T-cell therapy is feasible in patients with DLBCL who are ≥70 years of age and that age should not be a limiting factor. However, a rehabilitation period after treatment is essential before patients experience improved quality of life.
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