Recent research highlights the importance of considering frailty markers—particularly physical deconditioning and malnutrition—in patients with lymphoma receiving chimeric antigen receptor T-cell (CAR-T) therapy.
“Patients undergoing CAR T-cell therapy face unique toxicities and hospitalization outcomes that vary significantly in incidence and severity,” wrote the authors, led by Aaron Murray of the University of Nebraska Medical Center in Omaha. “Evaluating biomarkers of frailty may help identify patients at risk for adverse outcomes and allow for enhanced care planning.”
The study aimed to identify frailty markers associated with higher risk for toxicities, longer hospitalization, higher utilization of ancillary healthcare services, and worse overall outcomes.
The sample included 143 patients with diffuse large B-cell lymphoma (DLBCL) or high-grade lymphoma with a median age of 64 years who had received CAR-T therapy from 2018 to 2024 (lisocabtagene maraleucel, n = 100; (axicabtagene ciloleucel, n = 43). The researchers assessed Glasgow Prognosis Scale (GPS), Eastern Cooperative Oncology Group (ECOG) performance scores, nutrition status, and polypharmacy.
Before starting CAR T-cell therapy, 104 patients (72%) had a GPS score of 0, 31 (22%) had a GPS score of 1, and eight (6%) had a GPS score of 2. On ECOG, 110 patients (80%) had a score of 1 or more. In addition, 45 patients (31%) were diagnosed with malnutrition, and 87 patients (61%) had five or more chronic medications.
Analysis revealed that GPS score is significant. A score of 1 or 2 was associated with an increased risk for immune effector cell associated neurotoxicity syndrome (ICANS) grade 1 through 4 (66% versus 30% for those with GPS score of 0) and cytokine release syndrome grade 1 through 4 (85% versus 57%). Higher GPS score was also associated with increased utilization of supportive care, specifically increased referrals to physical therapy (77% versus 37%) and nutrition consultations (79% versus 45%).
Results also indicated that GPS and ECOG scores, polypharmacy, and malnutrition diagnosis were associated with increased length of stay. Higher GPS score was further associated with increased risk for discharge to an acute rehabilitation center or long-term acute care center. Finally, all four markers were associated with poorer overall survival.
“Our findings highlight the clinical impact frailty markers have on identifying patients with increased care needs and higher risk of poor outcomes. These data support efforts to study early intervention strategies to improve physical de-conditioning and malnutrition for patients with lymphoma undergoing CAR T-cell therapy,” the authors concluded.
Reference
Murray A, Shostrom V, Bociek R, et al. Frailty markers associated with impaired survival and hospitalization outcomes for patients with aggressive B-cell lymphoma receiving CAR T-cell therapy. Abstract 785. Presented at: the 67th American Society of Hematology Annual Meeting and Exposition, Dec. 6-9, 2025, Orlando, FL.
