Sociodemographic Factors Influencing Access to Chimeric Antigen T-Cell Receptor Therapy for Patients With Non-Hodgkin Lymphoma

• Published in: Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2024-09
• Main Authors: Khare, Somya, Williamson, Staci, O'Barr, Brittany, Schachter, Levanto, Chen, Andy, Hayes-Lattin, Brandon, Leonard, Jessica, Desai, Amrita, Ferreira-Gandolfo, Peter, Christmas, Kevin, Lackey, Denise, Maziarz, Richard T, Nemecek, Eneida R.
• Format: Article
• Language: English
• Subjects: Access; CART therapy; Cellular therapy; Healthcare disparities; Non-Hodgkin lymphoma
• ISSN: 2152-2650; 2152-2669; 2152-2669
• DOI: 10.1016/j.clml.2024.09.010

Chimeric antigen receptor T-cell (CAR-T) therapies are available for patients with Non-Hodgkin Lymphoma (NHL); however, their use has been limited in accessibility due to nondisease factors. We conducted a retrospective study evaluating the influence of sociodemographic factors on access and outcomes after CAR-T therapy for adult patients with B-cell NHL in our institution treated between 2016 and 2023. Among 154 patients treated with CAR-T, 43% were older than 65 years, 68% male, and 14% non-White (including Hispanic). Of those under 65, 66% had private insurance, while 82% over 65 had Medicare. Most patients (85%) were from in-state, 29% from areas below the national poverty level and 18% from nonmetropolitan areas. Distance to the treatment center was greater than 30, 60 or 120 miles for 52%, 40% and 29% of patients, respectively. No significant differences were found in the use of commercial versus investigational products among racial/ethnic minorities or those living >60 miles from the center. However, patients from nonmetropolitan areas and those below the national poverty level were less likely to receive commercial products. With a median follow-up of 11 months, the 1-year overall survival (OS) was 63.2% (95th CI 59.9%-66.8%). Poverty was associated with lower 1-year OS (HR 0.4, 95th CI 0.17-0.90, P = .031). Our study shows that CAR-T therapy can be delivered across sociodemographic barriers and underscores the importance of considering social determinants of health to optimize access for all patients. [Display omitted] We evaluated the impact of sociodemographic factors on access and outcomes for 154 adults with B-cell NHL treated with CAR-T therapy (2016–2023). Patients from nonmetropolitan areas and those below the poverty level were less likely to receive commercial products. Poverty was associated with lower 1-year survival. Addressing social determinants is essential to improve equitable access to CAR-T therapy.