Dr Ruella on Access Disparities to CAR T-Cell Therapy in Minority Patients With Myeloma

“We saw a progressive reduction of the percentage of [minority] patients…when you go from the catchment area to the cancer center, but in particular to the CAR T-cell [cohort]. So, the study suggests that there might be a gap in access to BCMA-[directed] CAR T-cell [therapy] for the minority health population.”

Marco Ruella, MD, assistant professor of medicine, Division of Hematology/Oncology, Center for Cellular Immunotherapies; scientific director, Lymphoma Program, Hospital of the University of Pennsylvania, discusses findings highlighting disparities in access to commercial BCMA-directed CAR T-cell therapy among minority health populations with multiple myeloma.

Multiple myeloma disproportionately affects African American patients, with a higher incidence compared with other racial groups, Ruella begins. Despite this, data suggest that minority patients face significant barriers to accessing advanced treatments, such as CAR T-cell therapy.

A retrospective analysis published in Blood evaluated the representation of minority patients in multiple myeloma populations across three levels: patients diagnosed with multiple myeloma in the Abramson Cancer Center catchment area, patients receiving care at Abramson Cancer Center, and patients treated with commercial BCMA-directed CAR T-cell therapy at the Abramson Cancer Center.

Patient outcomes in the third cohort, which included 100 non-minority health population patients and 22 minority health population patients, were the focus of the analysis. Baseline characteristics were similar, although the median age of the minority health population was younger compared with the non-minority health population, at 61 years vs 65 years. Similarly, these patients had received fewer median prior lines of therapy, at 6 vs 7, respectively.

Both groups had comparable efficacy outcomes, with 68.1% of minority health population patients and 70.7% of non-minority health population patients achieving at least a very good partial response. Median progression-free survival was 14.7 months for minority health population patients vs 16.5 months for non-minority health population patients.

Overall survival (OS) did not differ between groups, with medians that were not reached in either population. No significant differences in safety were observed, with comparable rates of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), respectively, in the minority (91%; 9.1%) and non-minority (78%; 21%) health populations. 

Social determinants of access were also examined. Minority health population patients lived closer to the CAR T-cell therapy center vs non-minority health population patients, with a median travel time of 35 minutes vs 63 minutes, respectively. The respective median travel times were 27 minutes and 40 minutes for only those patients within the catchment area. Additionally, minority health population patients were less likely to be married vs non-minority health population patients, at a rate of 45.5% vs 79.0%, respectively. Employment status and insurance type did not differ by minority status.

Understanding the causes of these disparities is the next critical step, Ruella notes. Access to CAR T-cell therapy is influenced by multiple factors, including socioeconomic determinants, health care provider biases, patient hesitancy, and logistical challenges such as geographic distance from treatment centers. Future efforts will focus on identifying and addressing barriers to access, with the goal of implementing effective strategies to ensure all eligible patients can benefit from advanced immunotherapies, Ruella concludes.