Assessing Medicaid Coverage for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy: A Project from the American Society for Transplantation and Cellular Therapy and the National Marrow Donor Program ACCESS Initiative

Auletta, Jeffery J.; Khera, Nandita; DeMartino, Patrick; Kelkar, Amar H.; Yusuf, Rafeek A.; Davies, Stella M.; Knutson, Jessica; Beaver, Ellie; Maloney, Alycia; Majhail, Navneet S.

doi:10.1016/j.jtct.2023.08.007

Cited by 9 publications

(2 citation statements)

References 28 publications

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“…Efforts are needed to ensure reimbursement of these increased costs including through Medicare/Medicaid. 29 Lack of addressing this barrier to URD availability will disproportionately adversely affect underserved patient populations. Centers need internal guidelines outlining the maximum degree of URD HLA mismatch that will be acceptable for their program.…”

Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Fingrut,

Davis,

Archer

et al. 2024

Blood Advances

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Despite the global unrelated donor (URD) registry size, the degree to which URD availability is a transplant barrier is not established. We evaluated the availability of 3,843 URDs requested for 455 diverse adult patients (predominantly with acute leukemia). URDs for non-Europeans were more likely to be domestic and had markedly lower Donor Readiness Scores. Of URDs requested for confirmatory HLA-typing (CT) alone (i.e. without simultaneous workup), 1,894/3,529 (54%) were available. Availability of domestic URDs was 45%. Donor Readiness Score was highly predictive of CT availability. Compared with Europeans (n=335), more non-European patients (n=120) had >10 URDs requested and <5 available. Of workup requests (after CT or CT-workup), <70% (604/889, 68%) were available. More non-Europeans had <2 URDs available. URD availability for CT was markedly worse for non-Europeans, with availabilities for African, non-Black Hispanic, and Asian patients of 150/458 (33%), 120/258 (47%) and 119/270 (44%), respectively, with further decrements in URD workup availability. Our data suggest the functional size of the URD pool is much smaller than appreciated, mandating major operational changes for transplant Centers and donor registries. Likelihood of donor availability should have a high priority in donor selection. Considering patient ancestry and URD Donor Readiness Scores, Centers should pursue, and registries permit, simultaneous pursuit of many URDs, and abandon futile searches. Patients should be informed about their likelihood of donor availability and alternative options. Finally, while registries should address high URD attrition and speed procurement, use of all HLA-disparate graft types is needed to facilitate timely transplantation for all.

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Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Fingrut,

Davis,

Archer

et al. 2024

Blood Advances

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“…A study from the ASTCT-NMDP ACCESS Initiative assessing barriers to HCT and CAR T-cell therapy found that many states across the United States have potentially discriminatory policy restrictions and inadequate support for patients and their caregivers (eg, noncoverage if patient has a child with nonsuitable family support or history of mental illness) that result in financial burden when seeking these treatments. 31 Timely allogeneic and autologous HCT is particularly low in Black patients compared with in White patients. 32 , 33 , 34 This can affect rate of survival 1 year after transplant 35 , 36 and access to proper posttransplant therapies.…”

Section: Discussionmentioning

confidence: 99%

Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity

Locke,

Siddiqi,

Jacobson

et al. 2024

Blood

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Axicabtagene ciloleucel (axi-cel) is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy approved for treatment of relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Despite extensive data supporting the use of axi-cel in patients with LBCL, outcomes stratified by race and ethnicity groups are limited. Here, we report clinical outcomes with axi-cel in patients with R/R LBCL by race and ethnicity in both real-world and clinical trial settings. In the real-world setting, 1290 patients with R/R LBCL who received axi-cel between 2017-2020 were identified from the Center for International Blood and Marrow Transplant Research database; 106 and 169 patients were included from the ZUMA-1 and ZUMA-7 clinical trials, respectively. Adjusted odds ratio (OR) and hazard ratio (HR) for race and ethnicity groups are reported. Overall survival was consistent across race/ethnicity groups. However, non-Hispanic (NH) Black patients had lower overall response rate (OR, 0.37, [95% CI, 0.22-0.63]) and lower complete response rate (OR, 0.57, [95% CI, 0.33-0.97]) than NH-white patients. NH-Black patients also had a shorter progression-free survival versus NH-white (HR, 1.41, [95% CI, 1.04-1.90]) and NH-Asian patients (HR, 1.67, [95% CI, 1.08-2.59]). NH-Asian patients had a longer duration of response compared with NH-white (HR, 0.56, [95% CI, 0.33-0.94]) and Hispanic patients (HR, 0.54, [95% CI, 0.30-0.97]). There was no difference in cytokine release syndrome by race/ethnicity; however, higher rates of any-grade ICANS were observed in NH-white patients compared with other patients. These results provide important context when treating patients with R/R LBCL with axi-cel across different racial and ethnic groups. ZUMA-1 (NCT02348216) and ZUMA-7 (NCT03391466), both registered on ClinicalTrials.gov

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Proceedings of the 2023 Second Annual ASTCT-NMDP ACCESS Initiative Workshop

Auletta,

Holter-Chakrabarty,

Jain

et al. 2023

Transplantation and Cellular Therapy

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Assessing Medicaid Coverage for Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy: A Project from the American Society for Transplantation and Cellular Therapy and the National Marrow Donor Program ACCESS Initiative

Cited by 9 publications

References 28 publications

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Racial/ethnic disparities in availability of volunteer unrelated donors for allogeneic transplantation

Real-world and clinical trial outcomes in large B-cell lymphoma with axicabtagene ciloleucel across race and ethnicity

Proceedings of the 2023 Second Annual ASTCT-NMDP ACCESS Initiative Workshop

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