CD19 CAR T-cell therapy for relapsed/refractory diffuse large B-cell lymphoma in a nonagenarian patient

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the management of relapsed/refractory large B-cell lymphoma. However, evidence in the ultra-elderly population remains scarce. We report a 90-year-old woman with relapsed/refractory diffuse large B-cell lymphoma transformed from follicular lymphoma who received lisocabtagene maraleucel. Despite advanced age, preserved cognition, intact instrumental activities of daily living, and acceptable organ reserve supported her candidacy for CAR T-cell therapy. Cytokine release syndrome (CRS) developed as grade 1 (day 1, 38.0 °C) and grade 2 (day 3, hypoxemia to 6 L/min), which resolved after early tocilizumab and dexamethasone. No immune effector cell-associated neurotoxicity syndrome or infectious complications occurred. Grade 2-4 cytopenia persisted transiently but was managed with supportive care, and she was discharged on day 28. To our knowledge, this represents the first reported case of a nonagenarian Asian patient successfully treated with CAR T-cell therapy, highlighting the feasibility and tolerability of this approach and emphasizing the importance of geriatric assessment and prompt CRS management for safe delivery in the very elderly.