Assessment of Time to Insurance Approval and Distance Traveled in Patients Treated with CAR T-Cell Therapy for Relapsed or Refractory Diffuse Large B-Cell Lymphoma

• Published in: Biology of blood and marrow transplantation 2020-03, Vol.26 (3), p.S272-S272
• Main Authors: Thiel, Grace, Schmit-Pokorny, Kim, Swanson, Deborah, Jourdan, Dawn, Franco, Theresa, Shostrom, Valerie K., Armitage, James O., Bierman, Philip J., Bociek, R. Gregory, Kallam, Avyakta, Vose, Julie M., Lunning, Matthew A.
• Format: Article
• Language: English
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2019.12.441

Chimeric Antigen Receptor (CAR) T-cell therapy has been approved for the treatment of relapsed or refractory diffuse large B-cell lymphoma (DLBCL). Long-term follow-up of the ZUMA-1 trial demonstrated that 39% of patients who received axicaptogene ciloleucel were progression free at two-years. CAR-T cell therapy, as a treatment option, has likely been hindered by logistical barriers, including patients’ insurance approval/single case agreement (SCA) process and the distance to the CAR-T treatment center from their home. Patient (Pt) information was retrospectively reviewed from our commercial CAR-T cell therapy experience between 1/2018 and 7/2019. Standard patient demographics and disease characteristics were collected. Progression free survival (PFS) and overall survival (OS) time points started with the treating physician's documentation of intent to CAR-T (iCAR-T). Pts were further assessed based on public (Medicare/Medicaid) or private insurance and distance from CAR-T center to home (> or ≤ than 120 miles). Statistical analysis was then completed on the data. Fischer's Exact tests and Mann-Whitney tests were used to compare the patients, while log-rank tests were used to compare Kaplan-Meier Curves. A total of 25 pts were reviewed. Four pts had intended to be apheresed for CAR-T but did not reach the apheresis time point. In the entire cohort, the median PFS and OS have not been reached. The median follow-up was 5.5 months (range: 1.5 to 15 months) for those infused with CAR-T. Pts with public insurance (N=7) received CAR-T infusion more quickly (p = 0.0080) than those with private insurance (N=14). However, this did not influence PFS (p = 0.2856) or OS (p = 0.5073) with balanced disease and demographic characteristics other than age < 65 in the private insurance cohort. Furthermore, the distance traveled (>120 miles; N=10 or ≤ 120 miles; N=11) from a patient's home to the CAR-T center did not affect PFS (p = 0.8914) or OS (p = 0.9078). Neither analysis for PFS or OS was significantly altered with the addition of the iCAR-T population. In this experience, pts with public insurance appear to proceed from agreement to CAR-T with subsequent CAR-T infusion (Brain to Vein) more quickly, but the time to apheresis does not appear to affect outcome. Also, the distance from the CAR-T cell center does not appear to be a predictor for worse outcomes. Both logistical barriers occurring pre-apheresis warrant further assessment in a larger multicenter experience.