Elderly patients can receive CAR T-cell therapy, and age alone is not a contraindication. However, considerations such as frailty, performance status, and comorbidities play a significant role in determining eligibility and outcomes.
Here are the key findings:
Efficacy in Elderly Patients
- Studies show that CAR T-cell therapy is effective in patients aged 65 years and older, with outcomes comparable to younger patients in terms of response rates and survival.
- In real-world data, elderly patients (≥70 years) achieved similar complete remission (CR) rates and overall survival (OS) as younger counterparts when selected based on good performance status.
- For patients aged ≥75 years, the event-free survival (EFS) was lower compared to younger groups, but the overall survival remained similar across age categories.
Safety Profile
- The incidence of severe toxicities like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) is comparable between elderly and younger patients, though older individuals may experience slightly higher rates of severe neurotoxicity.
- Non-relapse mortality at 1 and 3 months post-treatment is low in elderly patients, indicating manageable safety risks.
Challenges for Elderly Patients
- Frailty and comorbidities can make elderly patients more susceptible to treatment-related adverse events.
- Older patients often face barriers to accessing CAR T-cell therapy due to preconceived biases about their ability to tolerate intensive treatments.
Conclusion
CAR T-cell therapy is a viable option for elderly patients with relapsed/refractory large B-cell lymphoma or other eligible conditions. Proper patient selection based on fitness rather than age is crucial to achieving favorable outcomes.
Photo: 7th European CAR-T conference. Strasbourg, France 2025.
Sources:
pubmed
haematologica.org
onco-hema
consultqd.clevelandclinic.org
nature.com
ashpublications.org
ashpublications.org
Publication date: March 2025
