ASH 2024 | CAR T-cell access disparities: race and socioeconomic status

In our center, we have been seeing that a lot of patients who are being listed for CAR T-cell therapy for various relapsed/refractory hematological malignancies are not ending up getting the CAR-T. We had published a study sometime back which showed that 50% of the patients in our hospital who were listed for CAR T-cell therapy did not actually get it. So we were trying to find out what were the factors that were preventing them from getting access to the CAR T-cell therapy. Being the only CAR T-cell therapy in our state of Arkansas, we had this unique opportunity to see where the patient is coming from and see the travel distance or the socioeconomic status of the community that they are living in is responsible for this barrier to access. And for this, we accumulated the data of all the patients who were listed for CAR T-cell therapy in our center. So a total of 291 patients were listed for CAR T-cell therapy for various relapsed/refractory hematological malignancies. So we looked at their address and saw what was their travel distance to our center. Also, we looked at what is called a social vulnerability index. It’s an index that’s provided by CDC for each county. And it takes into account 15 different variables like the economic status of the community, the literacy rate, the income, the hospitals in the setting. And using all of these factors, CDC gives a social vulnerability index to each county, which has previously been shown to be associated with various health-related outcomes. We used social vulnerability index as a proxy to socioeconomic factors. Using these two factors, we saw this was impacting the access to CAR T-cell therapy. What we saw was that the social vulnerability index or travel distance did not matter in whether the patient got the CAR T-cell therapy or not. But then what was something interesting was if you are a Caucasian, you had more than 50% chance of getting CAR-T, exactly 52% chance of getting CAR-T after being listed, compared to 36% if you were African American. What that means is one in two patients who are listed for CAR-T, white patients listed for CAR-T end up getting CAR-T, one in three African American patients listed for CAR-T end up getting CAR-T, which was significantly different. The other important thing that we found was people coming from lower socioeconomic communities, people where the social vulnerability was very high, they had a long wait time from diagnosis to being listed for CAR-T. They are probably there in the community and getting a lot of next lines of therapy before being listed for CAR T-cell therapy. This identifies various non-disease related factors that influence access to CAR-T, which needs to be addressed so that we have equitable access to healthcare.

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