Axicabtagene Ciloleucel for Lymphoma in Patients Aged 75 and Older: A Retrospective Cohort Study

Introduction Strategies for managing older patients with relapsed/refractory (R/R) B-cell non-Hodgkin lymphoma (NHL) remain an unmet clinical need. CD19-directed chimeric antigen receptor T-cell (CART) therapy has become the standard of care for many NHL patients in the R/R setting, though its effectiveness and toxicity profile in older patients remains incompletely characterized. Objectives We sought to study the outcome and safety of axicabtagene ciloleucel (axi-cel) administration for R/R NHL patients aged ≥ 75 years. Methods We analyzed consecutive patients aged ≥ 75 years at a single center who received axi-cel for R/R NHL. The primary outcome was overall survival (OS). Secondary outcomes included event-free survival (EFS), defined as time to next therapy, relapse/progression, or death; incidence of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS); and hematologic and non-hematologic toxicities. Results A total of 15 patients were included, with a median age of 78 years and 40% older than 80 years (Table 1). Most patients were treated for diffuse large B-cell lymphoma (n=13, 87%), as well as 1 patient for transformed chronic lymphocytic lymphoma and 1 for follicular lymphoma. The median follow-up was 25 months (range: 14-31). The 2-year EFS and OS were 53% (95% CI: 33-86) and 61% (39-98), respectively (Figure A). Five patients subsequently relapsed; 2 achieved response to subsequent polatuzumab vedotin-based therapy (Figure B).There was 1 event each of grade ≥ 3 CRS and ICANS. Hematologic toxicity was common; 9 (60%) patients developed grade 4 neutropenia, and 9 (60%) experienced febrile neutropenia. Grade ≥ 3 thrombocytopenia was seen in 10 (67%) patients; 3 required platelet transfusions. Four patients (27%) developed anemia requiring transfusion. Infections were seen with bacterial (n=5, 33%), viral (n=5, 33%), and fungal (n=1, 7%) etiologies. The median length of hospital stay was 17 days (range: 13-35), and 2 patients required re-hospitalization within 100 days. One new arrhythmia was observed (symptomatic bradycardia). Conclusion We studied the outcomes of patients aged ≥ 75 years who received axi-cel for R/R NHL at our center. Although limited by sample size, we observed a toxicity profile consistent with what has been reported in younger recipients with low rates of high-grade toxicities, alongside promising efficacy. These results suggest that axi-cel may have a role in the treatment of carefully selected elderly patients with R/R NHL.