Therapy Socioeconomic and Racial Disparity in Chimeric Antigen Receptor T Cell Therapy Access

Chimeric antigen receptor (CAR) T cell therapy is changing the paradigm in hematologic malignancies, but disparities in access exist in the real-world setting. Efforts to address and eliminate these disparities will ensure availability of this life-saving therapy. This study aimed to determine patterns of racial/ethnic distribution, socioeconomic strata, insurance coverage, and travel time of CAR T cell recipients. We used the Vizient Clinical Database (CDB) to capture and analyze elective encounters for CAR T administration as well as encounters for any reason other than CAR T administration (non-CART) in patients with lymphoma, myeloma, and acute lymphoblastic leukemia. Travel time and median household income were calculated based on ZIP code of residence. We found that African Americans (AA) were less likely than other racial/ethnic groups to receive CART cell therapy. In addition, AA and Hispanic participants were underrepresented in clinical trials. Among the patients with myeloma, all of whom received CART cell therapy on a clinical trial, only 1% were African American and 5.4% were Hispanic, and only 7.3% of CART cell therapy-related admissions were of patients from neighborhoods with a mean income $40,000. Almost one-third of the CAR T cell recipients lived 2 hours away from the center in which they were treated; the majority of these patients were from the higher socioeconomic stratum (P < .001). There were fewer patients with Medicare and uninsured patients in the CAR T cell group. Our data indicate that socioeconomic stratum and insurance coverage are important underlying determinants of the identified disparities. Low clinical trial enrollment of minorities also feeds the inequity. Strategies to improve access need to be framed around addressing the causes for the observed disparities. ?? 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Automated summary

CAR T cell therapy has shown disparities in racial/ethnic distribution, socioeconomic strata, and insurance coverage, with African Americans and Hispanics being underrepresented. Patients living farther from treatment centers tend to be from higher socioeconomic backgrounds. Low enrollment of minorities in clinical trials contributes to these disparities, indicating a need for strategies to address the root causes.