Demographic differences among patients treated with chimeric antigen receptor T‐cell therapy in the United States

Abstract

Background It is not clear if all Americans have benefitted equally from the availability of chimeric antigen receptor T‐cell (CART) therapy. We aimed to evaluate if demographic differences existed among adult patients who received CART therapy and to assess predictors of CART treatment outcomes. Methods Records of patients ≥18 years who received CART therapy for non‐Hodgkin’s lymphoma, acute lymphoblastic leukemia, and multiple myeloma in 2018 were evaluated in the National Inpatient Sample. Acute complications and inhospital mortality were compared between two groups of CART recipients: Whites and non‐Whites. Logistic regression analysis was used to evaluate the association between sociodemographic factors and inhospital mortality. Results Of 1275 CART recipients that met inclusion criteria, there were 40.4% of females, 66.9% of Whites, Blacks (4.2%), Hispanics (13.3%), Asians or Pacific Islanders (4.2%), and Native Americans (1.3%). Up to 96.8% of CART procedures were performed in urban teaching hospitals, and 85.3% of CART recipients lived in metropolitan counties. Non‐Whites, compared to Whites, were younger at the time of CART therapy (p < 0.001). The inhospital mortality rate was higher in non‐Whites, though not statistically significant (5.4% vs. 4.4%, p = 0.764). There were no differences in length of hospital stay, hospital charges, or rates of acute toxicities between the two race groups. We found no association between race and treatment outcomes. Gender, neurotoxicity, and Charlson Comorbidity Index were significant predictors of inhospital mortality. Conclusions CART therapy recipients in the United States were more likely to be Whites and more likely to be residents of metropolitan areas. These observed demographic differences were not associated with treatment outcomes or inhospital mortalities.

Chimeric Antigen Receptor T-Cell Therapies: Barriers and Solutions to Access

“…55,56 Similarly, a retrospective study of US patients who received CAR-T therapy in an inpatient setting suggests that Black individuals are underrepresented among patients who receive CAR-T treatment. 57 This report is consistent with data from the Center for International Blood and Marrow Transplant Research, which demonstrated that of all individuals receiving CAR-T treatment in the United States from 2016 to 2021, 79% were White, whereas Asian and Black individuals represented 4% and 6% of the population included in the analysis, respectively. 58 Overall, Black American and Hispanic patients are also reported to receive novel MM therapies later than White patients, and they may not receive the full benefit of these therapies given this late introduction.…”

Racial and ethnic differences in clinical outcomes among patients with multiple myeloma treated with CAR T-cell therapy

“…Despite lower ide-cel response among Hispanic patients, we did not observe differences in OS or PFS based on race and ethnicity among patients with RRMM treated with SOC ide-cel. A few prior studies have examined racial and ethnic differences in CAR T-cell therapy outcomes, 15 , 16 , 19 , 20 , 21 but the generalizability of their findings to patients with RRMM was limited because of their focus on other hematologic malignancies, pediatric patients, patients treated as part of clinical trials, and/or small samples of patients with RRMM. Most of these past studies that focused on adult patients did not observe racial and ethnic differences in PFS and OS after CAR T-cell therapy, which is consistent with findings in this study.…”

“… 11 , 12 , 13 , 14 Access to novel therapies, including CAR T-cell therapy, is also reduced for patients of racial and ethnic minority groups and those of a lower socioeconomic status. 15 , 16 Moreover, non-Hispanic Black patients have not experienced the same rate of improvement in survival outcomes over the last 2 decades as non-Hispanic White patients. 17 The drivers of these racial and ethnic disparities are likely complex and multifactorial but remain unclear.…”

“…Likewise, few studies of CAR T-cell therapy in RRMM or other cancer types have investigated racial and ethnic differences in adverse events and outcomes in the SOC setting. 15 , 16 , 19 , 20 , 21 To address this limitation, the goal of this study was to evaluate the safety and efficacy of ide-cel by race and ethnicity among patients with RRMM treated with SOC CAR T-cell therapy. To the best of our knowledge, this is the first investigation of potential racial and ethnic differences among recipients of SOC ide-cel CAR T-cell therapy for RRMM.…”

Experiences and perspectives on chimeric antigen receptor (CAR) T-cell therapy among recipients, carers and referrers (RE-TELL): a qualitative study to inform CAR T-cell service design

“…As a personalised cell and gene therapy involving gene modification of a patient’s own T-cells, access to treatment is limited by logistical challenges and cost, while varied concerns regarding the technology need to be addressed, including equity of access, optimising the patient and support person experience, and cell and data sovereignty 3–5. Internationally, CAR T-cell therapy provision has not consistently ensured equity of access,6 7 and equity has been highlighted as a key area of focus for ongoing development of this treatment modality 8…”