Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas

Abu Sayeef Mirza; Chitra Hosing; Francine Foss; Soyoung Kim; Amy Moskop; Temitope Oloyede; Muhammad Bilal Abid; Aimaz Afrough; Sairah Ahmed; Talha Badar; Pere Barba; Vijaya Raj Bhatt; Valerie I. Brown; Saurabh Dahiya; Abhinav Deol; Narendranath Epperla; Siddhartha Ganguly; Natalie S. Grover; Hamza Hashmi; Shahrukh Hashmi; Peiman Hematti; Gerhard C. Hildebrandt; John M. Hill; Nasheed M. Hossain; Uroosa Ibrahim; P. Connor Johnson; Mohamed A. Kharfan-Dabaja; Maxwell M. Krem; Lazaros J. Lekakis; Richard T. Maziarz; Hemant S. Murthy; Peter A. Riedell; María Queralt Salas; Geoffrey Shouse; Christopher Strouse; Monica S. Thakar; Cameron J. Turtle; Ann Woolfrey; Kitsada Wudhikarn; Jean A. Yared; Marcelo C. Pasquini; Lohith Gowda

doi:10.1016/j.bneo.2025.100187

Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas

Abu Sayeef Mirza
, Chitra Hosing
, Francine Foss
, Soyoung Kim
, Amy Moskop
, Temitope Oloyede
, Muhammad Bilal Abid
, Aimaz Afrough
, Sairah Ahmed
, Talha Badar
, Pere Barba
, Vijaya Raj Bhatt
, Valerie I. Brown
, Saurabh Dahiya
, Abhinav Deol
, Narendranath Epperla
, Siddhartha Ganguly
, Natalie S. Grover
, Hamza Hashmi
, Shahrukh Hashmi

Peiman Hematti, Gerhard C. Hildebrandt, John M. Hill, Nasheed M. Hossain, Uroosa Ibrahim, P. Connor Johnson, Mohamed A. Kharfan-Dabaja, Maxwell M. Krem, Lazaros J. Lekakis, Richard T. Maziarz, Hemant S. Murthy, Peter A. Riedell, María Queralt Salas, Geoffrey Shouse, Christopher Strouse, Monica S. Thakar, Cameron J. Turtle, Ann Woolfrey, Kitsada Wudhikarn, Jean A. Yared, Marcelo C. Pasquini, Lohith Gowda

University of South Florida
University of Texas MD Anderson Cancer Center
Yale University
Medical College of Wisconsin
University of Texas Southwestern Medical Center
Mayo Clinic Jacksonville, FL
Hospital Universitari Vall d'Hebron
University of Nebraska Medical Center
Pennsylvania State University
Stanford University
Wayne State University
University of Utah
Houston Methodist Hospital
University of North Carolina-Chapel Hill
Memorial Sloan-Kettering Cancer Center
Mayo Clinic Rochester, MN
University of Missouri
Dartmouth-Hitchcock Clinic
University of Pennsylvania
Icahn School of Medicine at Mount Sinai
Harvard University
VA Medical Center
Research Medical Center Brookside Campus
University of Miami
Oregon Health and Science University
The University of Chicago
Hospital Clínic of Barcelona
City of Hope National Med Center
University of Iowa
University of Washington
Fred Hutchinson Cancer Research Center
University of Sydney
Chulalongkorn University
Greenebaum Cancer Center

Research output: Contribution to journal › Article › peer-review

Abstract

Age may influence clinical outcomes after CD19-directed chimeric antigen receptor (CAR) T-cell (CAR-T) therapy. Real-world data on the survival and toxicity outcomes of older patients receiving CAR-T therapy are limited. We used data from the Center for International Blood and Marrow Transplant Research for adults with diffuse large B-cell lymphoma who received CAR-T therapy from May 2018 to June 2020. Cumulative incidence and severity of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) were reported. Efficacy and safety outcomes were assessed using age as a continuous variable and among 4 age groups: 18 to 54, 55 to 64, 65 to 74, and ≥75 years. Nearly half (44%) of 1916 total recipients were aged ≥65 years. Patients received either axicabtagene ciloleucel (75%) or tisagenlecleucel (25%). Overall rates of CRS and ICANS were 75% and 43%, and severe rates of CRS and ICANS were 9% and 21%, respectively. For all patients, 12-month overall survival (OS), progression-free survival (PFS), and relapse rates were 62%, 42%, and 55%, respectively. As a continuous variable, older age did not affect OS, PFS, and CRS; however, the risk of ICANS increased with age (hazard ratio [HR], 1.03; P < .001). At age >64 years, risk for ICANS increases (HR, 1.65;95% confidence interval (CI), 1.33-2.1; P < .001). In a categorical analysis, the 65 to 74-year age group had lower relapse risk (HR, 0.77;95% CI, 0.64-0.93; P = .005) than younger patients. CD19 CAR-T therapy is effective for older adults, and older age does not worsen mortality. Older age is associated with higher ICANS risk and should guide patient selection.

Original language	English
Article number	100187
Journal	Blood Neoplasia
Volume	3
Issue number	2
DOIs	https://doi.org/10.1016/j.bneo.2025.100187
State	Published - May 2026

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Mirza, A. S., Hosing, C., Foss, F., Kim, S., Moskop, A., Oloyede, T., Abid, M. B., Afrough, A., Ahmed, S., Badar, T., Barba, P., Bhatt, V. R., Brown, V. I., Dahiya, S., Deol, A., Epperla, N., Ganguly, S., Grover, N. S., Hashmi, H., ... Gowda, L. (2026). Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas. Blood Neoplasia, 3(2), Article 100187. https://doi.org/10.1016/j.bneo.2025.100187

@article{79c56d0d26664c40ad85aed4a3785e2b,

title = "Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas",

abstract = "Age may influence clinical outcomes after CD19-directed chimeric antigen receptor (CAR) T-cell (CAR-T) therapy. Real-world data on the survival and toxicity outcomes of older patients receiving CAR-T therapy are limited. We used data from the Center for International Blood and Marrow Transplant Research for adults with diffuse large B-cell lymphoma who received CAR-T therapy from May 2018 to June 2020. Cumulative incidence and severity of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) were reported. Efficacy and safety outcomes were assessed using age as a continuous variable and among 4 age groups: 18 to 54, 55 to 64, 65 to 74, and ≥75 years. Nearly half (44\%) of 1916 total recipients were aged ≥65 years. Patients received either axicabtagene ciloleucel (75\%) or tisagenlecleucel (25\%). Overall rates of CRS and ICANS were 75\% and 43\%, and severe rates of CRS and ICANS were 9\% and 21\%, respectively. For all patients, 12-month overall survival (OS), progression-free survival (PFS), and relapse rates were 62\%, 42\%, and 55\%, respectively. As a continuous variable, older age did not affect OS, PFS, and CRS; however, the risk of ICANS increased with age (hazard ratio [HR], 1.03; P < .001). At age >64 years, risk for ICANS increases (HR, 1.65;95\% confidence interval (CI), 1.33-2.1; P < .001). In a categorical analysis, the 65 to 74-year age group had lower relapse risk (HR, 0.77;95\% CI, 0.64-0.93; P = .005) than younger patients. CD19 CAR-T therapy is effective for older adults, and older age does not worsen mortality. Older age is associated with higher ICANS risk and should guide patient selection.",

author = "Mirza, \{Abu Sayeef\} and Chitra Hosing and Francine Foss and Soyoung Kim and Amy Moskop and Temitope Oloyede and Abid, \{Muhammad Bilal\} and Aimaz Afrough and Sairah Ahmed and Talha Badar and Pere Barba and Bhatt, \{Vijaya Raj\} and Brown, \{Valerie I.\} and Saurabh Dahiya and Abhinav Deol and Narendranath Epperla and Siddhartha Ganguly and Grover, \{Natalie S.\} and Hamza Hashmi and Shahrukh Hashmi and Peiman Hematti and Hildebrandt, \{Gerhard C.\} and Hill, \{John M.\} and Hossain, \{Nasheed M.\} and Uroosa Ibrahim and Johnson, \{P. Connor\} and Kharfan-Dabaja, \{Mohamed A.\} and Krem, \{Maxwell M.\} and Lekakis, \{Lazaros J.\} and Maziarz, \{Richard T.\} and Murthy, \{Hemant S.\} and Riedell, \{Peter A.\} and Salas, \{Mar{\'i}a Queralt\} and Geoffrey Shouse and Christopher Strouse and Thakar, \{Monica S.\} and Turtle, \{Cameron J.\} and Ann Woolfrey and Kitsada Wudhikarn and Yared, \{Jean A.\} and Pasquini, \{Marcelo C.\} and Lohith Gowda",

note = "Publisher Copyright: {\textcopyright} 2026 American Society of Hematology",

year = "2026",

month = may,

doi = "10.1016/j.bneo.2025.100187",

language = "English",

volume = "3",

journal = "Blood Neoplasia",

issn = "2950-3280",

publisher = "Elsevier BV",

number = "2",

}

Mirza, AS, Hosing, C, Foss, F, Kim, S, Moskop, A, Oloyede, T, Abid, MB, Afrough, A, Ahmed, S, Badar, T, Barba, P, Bhatt, VR, Brown, VI, Dahiya, S, Deol, A, Epperla, N, Ganguly, S, Grover, NS, Hashmi, H, Hashmi, S, Hematti, P, Hildebrandt, GC, Hill, JM, Hossain, NM, Ibrahim, U, Johnson, PC, Kharfan-Dabaja, MA, Krem, MM, Lekakis, LJ, Maziarz, RT, Murthy, HS, Riedell, PA, Salas, MQ, Shouse, G, Strouse, C, Thakar, MS, Turtle, CJ, Woolfrey, A, Wudhikarn, K, Yared, JA, Pasquini, MC & Gowda, L 2026, 'Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas', Blood Neoplasia, vol. 3, no. 2, 100187. https://doi.org/10.1016/j.bneo.2025.100187

TY - JOUR

T1 - Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas

AU - Mirza, Abu Sayeef

AU - Hosing, Chitra

AU - Foss, Francine

AU - Kim, Soyoung

AU - Moskop, Amy

AU - Oloyede, Temitope

AU - Abid, Muhammad Bilal

AU - Afrough, Aimaz

AU - Ahmed, Sairah

AU - Badar, Talha

AU - Barba, Pere

AU - Bhatt, Vijaya Raj

AU - Brown, Valerie I.

AU - Dahiya, Saurabh

AU - Deol, Abhinav

AU - Epperla, Narendranath

AU - Ganguly, Siddhartha

AU - Grover, Natalie S.

AU - Hashmi, Hamza

AU - Hashmi, Shahrukh

AU - Hematti, Peiman

AU - Hildebrandt, Gerhard C.

AU - Hill, John M.

AU - Hossain, Nasheed M.

AU - Ibrahim, Uroosa

AU - Johnson, P. Connor

AU - Kharfan-Dabaja, Mohamed A.

AU - Krem, Maxwell M.

AU - Lekakis, Lazaros J.

AU - Maziarz, Richard T.

AU - Murthy, Hemant S.

AU - Riedell, Peter A.

AU - Salas, María Queralt

AU - Shouse, Geoffrey

AU - Strouse, Christopher

AU - Thakar, Monica S.

AU - Turtle, Cameron J.

AU - Woolfrey, Ann

AU - Wudhikarn, Kitsada

AU - Yared, Jean A.

AU - Pasquini, Marcelo C.

AU - Gowda, Lohith

PY - 2026/5

Y1 - 2026/5

N2 - Age may influence clinical outcomes after CD19-directed chimeric antigen receptor (CAR) T-cell (CAR-T) therapy. Real-world data on the survival and toxicity outcomes of older patients receiving CAR-T therapy are limited. We used data from the Center for International Blood and Marrow Transplant Research for adults with diffuse large B-cell lymphoma who received CAR-T therapy from May 2018 to June 2020. Cumulative incidence and severity of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) were reported. Efficacy and safety outcomes were assessed using age as a continuous variable and among 4 age groups: 18 to 54, 55 to 64, 65 to 74, and ≥75 years. Nearly half (44%) of 1916 total recipients were aged ≥65 years. Patients received either axicabtagene ciloleucel (75%) or tisagenlecleucel (25%). Overall rates of CRS and ICANS were 75% and 43%, and severe rates of CRS and ICANS were 9% and 21%, respectively. For all patients, 12-month overall survival (OS), progression-free survival (PFS), and relapse rates were 62%, 42%, and 55%, respectively. As a continuous variable, older age did not affect OS, PFS, and CRS; however, the risk of ICANS increased with age (hazard ratio [HR], 1.03; P < .001). At age >64 years, risk for ICANS increases (HR, 1.65;95% confidence interval (CI), 1.33-2.1; P < .001). In a categorical analysis, the 65 to 74-year age group had lower relapse risk (HR, 0.77;95% CI, 0.64-0.93; P = .005) than younger patients. CD19 CAR-T therapy is effective for older adults, and older age does not worsen mortality. Older age is associated with higher ICANS risk and should guide patient selection.

AB - Age may influence clinical outcomes after CD19-directed chimeric antigen receptor (CAR) T-cell (CAR-T) therapy. Real-world data on the survival and toxicity outcomes of older patients receiving CAR-T therapy are limited. We used data from the Center for International Blood and Marrow Transplant Research for adults with diffuse large B-cell lymphoma who received CAR-T therapy from May 2018 to June 2020. Cumulative incidence and severity of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS) were reported. Efficacy and safety outcomes were assessed using age as a continuous variable and among 4 age groups: 18 to 54, 55 to 64, 65 to 74, and ≥75 years. Nearly half (44%) of 1916 total recipients were aged ≥65 years. Patients received either axicabtagene ciloleucel (75%) or tisagenlecleucel (25%). Overall rates of CRS and ICANS were 75% and 43%, and severe rates of CRS and ICANS were 9% and 21%, respectively. For all patients, 12-month overall survival (OS), progression-free survival (PFS), and relapse rates were 62%, 42%, and 55%, respectively. As a continuous variable, older age did not affect OS, PFS, and CRS; however, the risk of ICANS increased with age (hazard ratio [HR], 1.03; P < .001). At age >64 years, risk for ICANS increases (HR, 1.65;95% confidence interval (CI), 1.33-2.1; P < .001). In a categorical analysis, the 65 to 74-year age group had lower relapse risk (HR, 0.77;95% CI, 0.64-0.93; P = .005) than younger patients. CD19 CAR-T therapy is effective for older adults, and older age does not worsen mortality. Older age is associated with higher ICANS risk and should guide patient selection.

UR - https://www.scopus.com/pages/publications/105034581604

U2 - 10.1016/j.bneo.2025.100187

DO - 10.1016/j.bneo.2025.100187

M3 - Article

AN - SCOPUS:105034581604

SN - 2950-3280

VL - 3

JO - Blood Neoplasia

JF - Blood Neoplasia

IS - 2

M1 - 100187

ER -

Impact of age on outcomes after CD19 CAR T-cell therapy for large B-cell lymphomas

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