EBMT 2022 | Tackling inequalities in the field of stem cell transplantation and cellular therapies
Nico Gagelmann, MD, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, comments on inequalities in the field of stem cell transplantation (SCT) and cellular therapies such as chimeric antigen receptor T-cell (CAR-T) therapy, highlighting some of the efforts made to overcome them. Dr Gagelmann explains that a recent international survey exploring the obvious inequalities in SCT and cellular therapies identified differences in the access to education, communication, conferences, treatments, and clinical trials that were related to the country’s income status. It is important to be aware of these inequalities and take measures to overcome them, in particular in the context of these new costly cellular therapies. This interview took place at the 48th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2022, which was held virtually.
Transcript (edited for clarity)
From our training perspective, we call it inequality because we think that inequality is a broader approach to the problems we all face now, and the problems also change and evolve over time. And that’s why we were first established one year ago and then already tackled the inequalities we all intuitively felt we needed to address. And one particular inequality we all recognized is the access, access in various dimensions, access to education, access to certain conferences, access to treatments, access to clinical trials, access to communication...
From our training perspective, we call it inequality because we think that inequality is a broader approach to the problems we all face now, and the problems also change and evolve over time. And that’s why we were first established one year ago and then already tackled the inequalities we all intuitively felt we needed to address. And one particular inequality we all recognized is the access, access in various dimensions, access to education, access to certain conferences, access to treatments, access to clinical trials, access to communication. And that’s why we first wanted to identify what the inequalities really are at the moment. And then we did an international survey last year and could publish this in The Lancet Hematology on Saturday, which is free for everyone to read, where we identified obvious inequalities and differences between certain countries across the globe. So the survey covered almost all continents except Antarctica.
And there we found obvious inequalities in access of allogeneic stem cell transplantation and also autologous transplantation. But the biggest difference was regarding newer therapies, including cellular therapies with CAR-T treatment, where we found significant differences, according to the income status of countries and the access to these treatments. So only 5% of all countries with lower or upper middle income had access for trainees to this treatment, which is a huge difference to high income countries. But also we identified differences even between high-income countries regarding these new cellular therapies. So we need to take this into account if newer treatments with certain financial toxicity or financial burden, as we call it nowadays, are more and more used, that the differences increase rather than decrease. And we need to be aware of that and we need to tackle that.
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