Faculty Collaboration Database

New comorbidity index associated with survival after chimeric antigen receptor T-cell therapy for large B-cell lymphoma. Blood Adv 2026 Jan 13;10(1):217-227

Date

08/14/2025

Pubmed ID

40811818

Pubmed Central ID

PMC12811452

DOI

10.1182/bloodadvances.2024015599

Scopus ID

2-s2.0-105027158017 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

The cumulative impact of baseline comorbidities on outcomes of chimeric antigen receptor T-cell (CAR-T) therapy is not well established. Therefore, we developed and validated a Cellular Therapy Comorbidity Index (CT-CI) to predict outcomes following CD19-directed CAR-T therapy for large B-cell lymphoma (LBCL). Patients aged 18 or older receiving commercial CAR-T therapy for LBCL during 2017 to 2020 were selected from the Center for International Blood and Marrow Transplant Research registry. Patients were randomly assigned to training or validation cohorts. Comorbidities given weighted scores comprised the CT-CI, which was then validated for overall survival (OS) prognostication. A total of 1916 patients from 97 medical centers were included, with a median age of 64 years (19-91 years). About 70% of patients had comorbidities, such as cardiac disease (12%); diabetes (14%); hepatic dysfunction (mild, 8%; moderate to severe, 2%); psychiatric disturbance (18%); and pulmonary dysfunction (moderate, 15%; severe, 12%). The CT-CI was calculated, stratified patients in 3 categories, and was associated with increased mortality. Patients with higher CT-CI scores had worse OS (CT-CI 1: hazard ratio [HR], 1.37 [95% confidence interval [CI], 1.16-1.62; P < .001]; CT-CI 2: HR, 1.49 [95% CI, 1.17-1.89; P = .001]; CT-CI ≥ 3: HR, 2.55 [95% CI, 1.90-3.42; P< .001]). Higher CT-CI scores predicted treatment-related mortality and relapse. There was no correlation between the CT-CI score and CAR-T-related toxicities. The novel CT-CI score stratifies the effect of patient comorbidities on survival after CAR-T therapy and can be used for clinical decision-making and treatment selection in high-risk populations. However, comorbidities and fear of increased toxicity should not preclude patients from this effective therapy.

Author List

Greenbaum U, Hashmi H, Elsawy M, Kim S, Moskop A, Oloyede T, Awan FT, Bachanova V, Badar T, Bar M, Barba P, Beitinjaneh AM, Cashen A, Dholaria B, Farooq U, Foglesong J, Ganguly S, Hematti P, Hill LC, Jain MD, Jain T, Kebriaei P, Kittai AS, Locke FL, Lulla PD, McGuirk JP, Mead E, Mussetti A, Nishihori T, Olson AL, Pennisi M, Perales MA, Geethakumari PR, Riedell PA, Saber W, Shouval R, Shpall EJ, Magalhaes-Silverman M, Strouse C, Turtle CJ, Vallurupalli A, Wudhikarn K, Pasquini MC, Ahmed S, Sorror M

Authors

Peiman Hematti MD Professor in the Medicine department at Medical College of Wisconsin
Soyoung Kim PhD Associate Professor in the Data Science Institute department at Medical College of Wisconsin
Amy Moskop MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Wael Saber MBBS, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Comorbidity
Female
Humans
Immunotherapy, Adoptive
Lymphoma, Large B-Cell, Diffuse
Male
Middle Aged
Prognosis
Treatment Outcome
Young Adult