ICML 2025 | The impact of age on treatment decisions and outcomes in R/R LBCL

So we know age is still an important factor in patient stratification and treatment selection. It still is a part of our prognostic scores and studies have shown how it’s an independent negative prognostic factor for patients with large B-cell lymphoma. So as part of a sub-analysis of a larger population that we analyzed at Princess Margaret, relapsed/refractory, large B-cell lymphoma patients, we were interested in asking how does age impact not just survival outcomes, but specifically treatment selection. And what we realized is that unsurprisingly, survival outcomes are worse in our older population. Our older population was, the cutoff was at 70 years old. So our patients 70 and older had a worse overall survival, worse progression-free survival. And this does not surprise us. What we wanted to realize, what we wanted to investigate is whether, how strong of a bias this was for us when deciding what to do with these patients, especially because in second-line curative intent becomes very important for these patients. So curative intent is the definition is changing as CAR-Ts are moving into second line, but what historically this has meant is patients going through a platinum-based salvage therapy and then an autologous stem cell transplant. So what we realized is that in the older population, less patients were directed towards autologous stem cell transplant and in general curative intent. We expected to see this, but what was interesting is that curative intent does improve overall survival, even in an older population where mortality rates can be impacted also by non-lymphoma death. When you take this information and you add it to the fact that by looking at CAR-T, for example, less patients were eligible for CAR-T in the older population. But when you look at how many of these patients actually made it to CAR-T, which is one of the issues that we have with CAR-T is that we lose patients as we go from their eligibility to the actual infusion. Well this did not seem to be happening in a higher proportion with our older population. So when we take a look at our data I think the main conclusion that we come to is that it’s not about age, it’s about identifying the right kind of patient that can go on to more aggressive therapies, curative intent therapies. Our patients are very complex, frailty, comorbidities, all these aspects, fitness, they need to be kept in consideration and age is just a number and just because somebody has a certain age that should not preclude them from more aggressive and curative treatments.

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