CAR T-cell therapy successful in older non-Hodgkin’s lymphoma patients

In a first-of-a-kind study using 2 years of Medicare claims data for chimaeric antigen receptor (CAR) T-cell therapies in patients aged ≥60 years with non-Hodgkin’s lymphoma, researchers have found clear evidence that this population derives more clinical benefit from this treatment compared with other patients who did not receive CAR T cells.

Dr Karl M. Kilgore (Avalere, a healthcare consulting firm in Washington DC, USA) reported on 207 CAR T-cell recipients receiving Medicare (median age 71 years; 60% men; 87% Caucasian) [1]. In mid-2017, the 2 different CD19-directed CAR T-cell therapies tisagenlecleucel and axicabtagene ciloleucel were approved for the treatment of patients with relapsed or refractory large B-cell lymphoma who had already had ≥2 prior systemic therapies. The first claims came in October 2017, and the current study followed patients receiving either of these CAR T products until 30 September 2018. “This study provides the first real-world look at patients’ CAR T experience, using the first Medicare fee-for-service claims subsequent to product FDA approvals,” Dr Kilgore said.

Over 78% of this cohort had Charlson Comorbidity Index scores greater than 2 (range 2-15), indicating a complex group of patients. Half of the patients (51%) had one or more chronic condition, e.g. heart disease, chronic obstructive pulmonary disease, and chronic kidney disease.

The results showed that 73% of these patients remained alive at the end of 6-month follow-up. Hospital time after CAR T was reduced by 17% compared with the 6-month period prior to CAR T infusion. Median length of stay was 7 days in the pre-index period and 5 days in the post-index period. In addition, the number of visits to the emergency room decreased by nearly a third after the infusion as compared with that same period prior to infusion; accordingly, healthcare costs were 39% lower in the 6 months after infusion than the 6 months preceding infusion.

The investigators concluded that longer follow-up and a more comprehensive cost analysis is warranted, but the current data from this study indicate that age limitations for CAR T trials may not be necessary.

1. Kilgore K, et al. Abstract 793, ASH 2019, 7-10 December, Orlando, USA.

Posted on 5 March 202028 March 2024