接受 CAR-T 细胞治疗的复发/难治性大 B 细胞淋巴瘤老年患者神经毒性：一项多中心研究

Anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy is a standard treatment option in relapsed or refractory (RR) large B-cell lymphoma (LBCL), including older patients.

However, immune effector cell-associated neurotoxicity syndrome (ICANS)/neurotoxicity is frequent and can be debilitating, especially in older patients, and incidence and risk factors are not well defined in such patients. This retrospective multicenter study included older patients ( 65 yr) with RR LBCL treated with commercial CAR-T therapy between December 2017 and April 2023. The primary study outcome included 30-d cumulative estimates of ICANS, using deaths/progressions as competing risks. A total of 224 patients were included; among them, 131 (58%) received axicabtagene ciloleucel, 36 (16%) were treated with tisagenlecleucel, and 57 (25%) had lisocabtagene maraleucel.

The median age at CAR-T therapy was 71 yr (range 65 to 89), and 26 (12%) were 80 yr old. The 30-d estimates for all grades and grades 3 ICANS were 50. 9% (95% CI 44. 7 to 57. 9) and 29. 8% (95% CI 24. 0 to 37. 0), respectively. Age at CAR-T therapy did not impact incidence, onset, and duration of ICANS.

In contrast, ECOG PS scale of 2, an elevated lactate dehydrogenase level, and the use of axicabtagene ciloleucel were associated with a higher incidence of grade 3 ICANS. Age at CAR-T therapy did not impact the risks of ICANS in older patients with RR LBCL. Comprehensive neurocognitive and frailty assessments and appropriate candidate selections are crucial.