My study was about older patients who underwent treatment with the so-called CAR T-cell therapy for relapsed lymphoma. We know that, generally speaking, the results of this specific treatment above all ages are good, providing at least for a part of the patients even the chance to be cured even in the setting of a relapsed situation of aggressive lymphoma. But we know that there are special considerations, especially regarding toxicity for this treatment in the older population setting.
Our study was to see if, given a prophylactic treatment that is especially used normally when the side effect is ICANS or CRS, a cure, if we give this in a prophylactic setting if this can reduce the toxicity during the course of CAR T-cell treatment, especially in older patients.
What was the study design?
The study design was that we retrospectively analysed patients that received the prophylactic tocilizumab before the CAR T-cell treatment and compared that of a group of patients that have not received this kind of prophylactic treatment.
What were the results?
The results were, given that it’s a small number of patients but somehow reflects that CAR T-cell is still not so often used in the older populations, that we saw in a combined endpoint that included the use of steroids, the length of the hospitalisation and the need for Intensive Care Unit treatment and the need of special care after the patients left the hospital significantly different between the two groups so that we consider that this kind of treatment could probably reduce the toxicity for older patients who receive CAR T-cell treatment.
What is the clinical significance of these results?
The clinical significance, there are several things to talk about. One is that we definitely need more data, especially for the older patients regarding CAR T-cell treatment to enable them to get this kind of treatment. We think that one treatment with this IL-6 antibody, tocilizumab, is a very cost-effective measurement if we can avoid the need for ICU treatment, a number of really significant toxicities. So we think that this could really be something that could help older patients to get better through this treatment and, by saying that, motivate the treating physicians to consider even older patients for this kind of treatment.
What is next for this study?
Next is that we will try to analyse a larger group of patients to make our results more significant. Another thing that we will now test, together with another university hospital in Switzerland, is if we can do a special evaluation of older patients with something which is called a pragmatic geriatric assessment, if this can help us to see if this can predict several toxicities for patients that will undergo cellular therapies.
Is there anything else you would like to add?
While working on that, there are two things important to me. So the first thing is that we need really to be clear or try to define better which older patients qualify for CAR T-cell treatment which is still an intensive treatment. I don’t think that only the gut feeling of the treating physician is the right measurement, that we should really look deeper if there are, like the geriatric assessment, things that can help us to get a better picture of the patients. And even more. So we added as one endpoint how patients were still independent in their daily living after this treatment or if there was any need that they need to be treated afterwards in a care unit facility. These are endpoints that matter more to older patients and that should be included in studies that include older patients more.
