CAR T-Cell Therapy in Older Adults With Large B-Cell Lymphoma

Dr. Melody introduces a clinical scenario involving Mr. R, a 71-year-old patient with relapsed large B-cell lymphoma, well-controlled hypertension, mild stable chronic kidney disease, preserved independence, and strong caregiver support. Dr. Shah discusses how age alone should not automatically exclude patients from consideration for CAR T-cell therapy and explains that overall fitness, functional status, comorbidities, and physiologic reserve are more informative when assessing candidacy. He highlights evidence from studies of older and transplant-ineligible patients, along with real-world data showing that older adults, including those with geriatric vulnerabilities, can benefit from CAR T-cell therapy. Dr. Shah emphasizes that patients who fall outside traditional clinical trial parameters may still be appropriate candidates when assessed individually. The panel also discusses experience treating very elderly patients, with Dr. Shah and Dr. Perales noting that CAR T-cell therapy has been administered successfully in patients in their mid-80s and beyond. The discussion reinforces the importance of individualized assessment rather than chronological age alone when considering CAR T-cell therapy for older adults with large B-cell lymphoma.