Abstract
Chimeric antigen receptor(CAR) T-cell therapy is effective in relapsed/refractory large B-cell lymphoma(LBCL), but evidence in elderly patients(≥70y) is limited. We compared outcomes of tisagenlecleucel(tisa-cel) and axicabtagene ciloleucel(axi-cel) and assessed prognostic factors.
We analyzed 1,191 patients(aged ≥70y) reported to the EBMT(tisa-cel n=402; axi-cel n=789). Median follow-up was 22.7 months. Outcomes included cytokine release syndrome(CRS), immune effector cell–associated neurotoxicity syndrome(ICANS), overall survival(OS), progression-free survival(PFS), relapse incidence(RI), and non-relapse mortality(NRM). Multivariable models adjusted for age, sex, ECOG, disease status, prior transplantation, and year of infusion.
Median age at infusion was 74y; 65.6% were aged 70–75y. Progressive disease at infusion was 59% vs 53% for tisa-cel and axi-cel(p=0.04). Tisa-cel patients were older(74.0 vs 73.7y, p=0.019). At day-30, CRS(any grade) occurred in 62% vs 77%(p<0.001) and ICANS(any grade) in 22% vs 47%(p<0.001) for tisa-cel vs axi-cel. Kaplan-Meier(KM) and Cumulative incidence (CI) estimates for 1-year OS, PFS, RI, and NRM were 57%, 37%, 59%, and 4% with tisa-cel vs 63%, 50%, 41%, and 9% with axi-cel. Outcomes were similar across age groups(70–74, 75–79, ≥80y). In multivariable analyses, axi-cel was associated with improved PFS(HR 0.72, p<0.001) and lower RI(HR 0.59, p<0.001), but higher NRM(HR 1.75, p=0.01), ICANS(HR 2.25, p<0.001), and CRS(HR 1.29, p=0.009). There was a statistical trend of improved OS using axi-cel in univariate analyses(p=0.076), however it was not in multivariable analyses(HR=0.86, p=0.12)
In patients(≥70y), axi-cel achieved superior disease control and potentially better survival but at greater toxicity. Adverse prognostic factors included ECOG≥2, advanced disease before infusion, and earlier treatment year, while age itself did not influence outcomes.
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