Impact of Age on Early CAR T-Cell Therapy Toxicity: A Propensity Score Matching Analysis

Despite the growing use of CAR-T therapy, adults over 65 still receive this treatment less frequently than younger patients.

Using the Nationwide Readmissions Database (2018-2020), we analyzed 2928 CAR-T recipients, dividing them into young (18-40), middle-aged (41-65), and older adults (≥ 66). Propensity score matching (caliper of 0.2, 1:1:1 ratio) was performed. We adjusted for the following confounding variables: gender, comorbidities, and social factors including smoking, alcohol use, and illicit drug use.

Older adults had the highest rates of acute kidney injury (11.7% vs. 13.0% vs. 18.1%, p = 0.02) and cardiac complications (2.0% vs. 3.6% vs. 5.4%, p = 0.03). These three different age groups had comparable rates of leukopenia (45.0% vs. 42.7% vs. 39.1%, p = 0.10), infection (41.0% vs. 43.6% vs. 42.1%, p = 0.74), neurotoxicity (6.2% vs. 6.5% vs. 7.7%, p = 0.52), and pulmonary embolism (1.0% vs. 2.9% vs. 2.3%; p = 0.2). Despite the highest rates of non-home discharge among the older patients (14.0% vs. 7.5% vs. 8.8%), there were no significant differences in early mortality (5.2% vs. 6.2% vs. 6.7%, p = 0.34), 30-day readmission (23.1% vs. 23.8% vs. 24.4%, p = 0.48), prolonged index hospitalization (96.1% vs. 94.8% vs. 93.6%, p = 0.14), and total length of stay (21.2 days vs. 18.2 days vs. 21.3 days, p = 0.58).

CAR-T therapy is safe among older adults with close monitoring for cardiac and renal complications.