Geriatric Assessment in Patients Aged 70 Years and Older Considered for CAR T-Cell Therapy: A Retrospective Study

Background/Objectives: Population aging has increased the incidence of non-Hodgkin lymphoma in older adults, who often receive suboptimal treatment. Geriatric assessment is a key tool to evaluate frailty and guide therapeutic decisions. CAR T-cell therapy is effective but associated with significant toxicities, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which may be more severe in older patients. This study evaluated the role of geriatric assessments in patients aged 70 years and older referred for CAR T-cell therapy, focusing on patient profiles, treatment-related toxicities and clinical outcomes. Methods: This retrospective descriptive study included all patients aged 70 years and older for whom CAR T-cell therapy was considered at our institution between 15 December 2022 and 31 January 2026. Data were collected through medical record review. Descriptive and exploratory statistical analyses were performed. Results: A total of 43 patients aged 70 years or older with a diagnosis of refractory non-Hodgkin lymphoma underwent geriatric assessment prior to CAR T-cell therapy (median age: 73 years; 58% male). Most patients lived at home (98%), often with a cohabiting partner (65%). Polypharmacy (72%), mobility impairment (19%) and cognitive impairment (49%) were prevalent among our study population. Among the evaluated patients, CAR T-cell therapy was recommended in 35 cases, of whom 27 subsequently received treatment. In total, 85% developed CRS and 59% developed ICANS. ICANS occurred slightly more frequently in patients with pre-existing neurocognitive impairment (7 out of 11, 64%), compared with 9 out of 16 (56%) among those without cognitive impairment. The median length of hospitalization was 16 days. Mean overall survival post CAR T-cell therapy reached 324 days as of 31 January 2026 (median 277 days). Patients who were not recommended for CAR T-cell therapy exhibited a markedly higher burden of frailty compared with those who were and most of these vulnerabilities had not been identified before the geriatric evaluation. Conclusions: This study highlights the importance of oncogeriatric assessment in the context of CAR T-cell therapy to personalize treatment strategies according to patients' frailty profiles. It may help optimize the care plan, potentially identifying patients most likely to benefit from therapy, while minimizing treatment-related toxicities. It also helps estimate the risk of treatment-related toxicities and facilitates the identification of previously unrecognized vulnerabilities.