Composite age + comorbidity exclusion from CAR-T: age ≥75 with Charlson Comorbidity Index...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CAR-T-INELIGIBLE-AGE-COMORBID`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-TRANSCEND-NHL-001-ABRAMSON-2020` `SRC-ZUMA-1-NEELAPU-2017`

Red Flag Origin

Definition	Composite age + comorbidity exclusion from CAR-T: age ≥75 with Charlson Comorbidity Index ≥4, OR age ≥80 regardless of comorbidity (real-world median for CRS/ICANS mortality jump), OR significant cognitive impairment (MMSE ≤24 or documented dementia) precluding ICANS toxicity recognition and informed consent.
Clinical direction	hold
Category	fitness-eligibility

Trigger Logic

{
  "any_of": [
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 4
        }
      ]
    },
    {
      "comparator": ">=",
      "finding": "age",
      "threshold": 80
    },
    {
      "all_of": [
        {
          "comparator": "<=",
          "finding": "mmse_score",
          "threshold": 24
        }
      ]
    },
    {
      "finding": "cognitive_impairment_significant",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

ZUMA-1, TRANSCEND, JULIET enrolled patients up to age 76-77; real-world experience (CIBMTR, French DESCAR-T) shows acceptable safety to age 80 with selected fit patients but >80 carries 2-3x higher non-relapse mortality. Cognitive baseline matters because ICANS presents as encephalopathy (ICE score, hand-writing) — pre-existing dementia obscures detection. Liso-cel (TRANSCEND) had broadest age tolerability in trials due to favorable CRS profile. Frail-elderly alternatives: bispecifics (epcoritamab, glofitamab — outpatient escalation feasible) gaining ground. Distinguish from RF-CAR-T-INELIGIBLE-ORGAN (organ-driven) and RF-FRAILTY-AGE-G8-LOW (general geriatric flag).

Used By

Algorithms

ALGO-MCL-2L - ALGO-MCL-2L

Red flag

RF-DLBCL-CART-INELIGIBLE-POST-2L - Relapsed/refractory DLBCL post ≥2 prior systemic therapies, NOT a candidate for anti-CD19...
RF-DLBCL-CD20-POS-EPCORITAMAB-CANDIDATE - Relapsed/refractory DLBCL with confirmed CD20 expression on malignant B-cells, post ≥2 pr...
RF-DLBCL-CD20-POS-GLOFITAMAB-CANDIDATE - Relapsed/refractory DLBCL with confirmed CD20 expression on malignant B-cells, post ≥2 pr...