Real-World Evidence of CAR T-cell Therapy in Older Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma.

The emergence of chimeric antigen receptor (CAR) T-cell therapy has changed the treatment landscape for diffuse large B-cell lymphoma (DLBCL), however, real-world evidence reporting outcomes among older patients treated with CAR T-cell therapy is limited. We leveraged the 100% Medicare Fee-for-Service claims database and analyzed outcomes and cost associated with CAR T-cell therapy in 551 older patients (age ≥65) with DLBCL who received CAR T-cell therapy between 2018 and 2020. CAR T-cell therapy was used in third line and beyond in 19% of patients age 65-69, 22% among those age 70-74, compared to 13% of patients age ≥75. The majority of patients received CAR T-cell therapy in an inpatient setting (83%), with an average length of stay of 21 days. The median event-free survival (EFS) following CAR T-cell therapy was 7.2 months. Patients age ≥75 had significantly shorter EFS compared to patients age 65-69 and age 70-74 with 12-month EFS estimates of 34%, 43% and 52%, respectively (p = 0.002). The median overall survival was 17.1 months and there was no significant difference by age groups. The median total healthcare cost during the 90-day follow-up was $352,572 and was similar across all 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 and this age group had a lower rate of EFS which illustrates the unmet need for more accessible, effective, and tolerable therapy in older patients, especially in patients age ≥75.