Study Finds Low Rate of CAR T-cell Therapy in Older Adults With DLBCL

Event-free survival with chimeric antigen receptor (CAR) T-cell therapy for diffuse large B-cell lymphoma (DLBCL) was significantly shorter among patients 75 and older compared with patients aged 65 to 74, according to study findings published in Blood.

“The emergence of CAR T-cell therapy has changed the treatment landscape for DLBCL, however, real-world evidence reporting outcomes among older patients treated with CAR T-cell therapy is limited,” wrote corresponding author Dai Chihara, MD, PhD, of the University of Texas MD Anderson Cancer Center, Houston, Texas, and study coauthors.

Researchers analyzed outcomes and costs associated with CAR T-cell therapy for 551 patients with DLBCL aged 65 and older from the 100% Medicare Fee-for-Service claims database. Patients in the study received CAR T-cell therapy between 2018 and 2020.

Just 13% of patients 75 or older received CAR T-cell therapy as third line therapy or beyond, compared with 22% of patients aged 70 to 74 and 19% of patients aged 65 to 69, according to the study.

More than three-quarters of patients received CAR T-cell therapy in an inpatient setting. The average length of stay was 21 days. 

Following CAR T-cell therapy, the median event-free survival was 7.2 months. Only one-third of patients 75 or older attained 12-month event-free survival, compared with 52% of patients ages 70 to 74 and 43% of patients ages 65 to 69. The median overall survival, which did not differ significantly between age groups, was 17.1 months.

Health care costs during the 90-day follow-up totaled a median $352,572 and were similar across age groups.

“CAR T-cell therapy was associated with favorable effectiveness, but the CAR T-cell therapy use in older patients was very low, especially in patients age ≥75,” researchers wrote, “and this age group had a lower rate of event-free survival, which illustrates the unmet need for more accessible, effective, and tolerable therapy in older patients, especially in patients age ≥75.”

Reference:
Chihara D, Liao L, Tkacz J, et al. Real-world evidence of CAR T-cell therapy in older patients with relapsed/refractory diffuse large B-cell lymphoma. Blood. Published online June 20, 2023. doi:10.1182/blood.2023020197