Poverty, Opportunity May Impact CAR T-Cell Therapy Access, Outcomes

Household poverty levels aren't adversely associated with outcomes in pediatric patients who receive CD19 CAR T-cell therapy, according to findings presented at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 3-7, 2022, virtually and in Chicago.

The findings, which were presented by study author Haley Newman, MD, of Children's Hospital of Philadelphia (CHOP), reflect some inequities in access to cell therapy as well as the influence of neighborhood opportunity on survival that need to be explored further.

Given that pediatric patients from underserved populations are more likely to relapse or die from B-cell acute lymphoblastic leukemia (B-ALL), Newman and colleagues explored the effects of socioeconomic status on 206 pediatric patients who underwent CAR T-cell therapy either in a trial or with tisagenlecleucel (tisa-cel) at CHOP from 2012 through 2020.

Socioeconomic status was based on the household (private [n=132] or public insurance [n=74]) and neighborhood (address geocoded to Childhood Opportunity Index 2.0; high COI, n=151; low COI, n=50), with outcomes in overall survival and relapse-free survival recorded.

Among the study population, most participants were between ages 10 and 17; 58.3% were male, and 42.7% had previously undergone hematopoietic stem cell transplant. Of the participants, 63.6% were White non-Hispanic; 7.3% were Black or African American; 21.4% were Hispanic, and 7.8% were categorized as other. Overall, 36% were household poverty exposed (similar between local and referred patients), and 24.9% were based in neighborhoods with low COI.

Notably, those unexposed to poverty or with a high COI presented with a high disease burden (37.1% vs 26%, P = .049, 37.9% vs. 29.7%, P = .002), suggesting that there may be referral bias or a greater ability to advocate for CAR-T therapy among less disadvantaged patients with higher disease burden.

No signficant differences in overall survival by household poverty level were found after adjusting for age, race/ethnicity, disease burden, relapse status, and inotuzumab exposure (HR 0.86, 95% CI 0.50-1.48, P = .575) or for those with low COI (HR 1.03, 95% CI 0.53-1.99, P = .932); however, low COI was associated with worse relapse-free survival rates (HR 2.26, 95% CI 1.34-8.80, P = .002).

"Future institutional and multicenter studies should utilize patient-reported social determinants of health to investigate mechanisms driving these disparities and guide care delivery interventions to improve equity in access and outcomes," Newman and colleagues wrote, noting that interventions around improving equitable access among patients with high disease burden is important.

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REFERENCE

Newman H, Li Y, Liu H, et al. Impact of socioeconomic status on survival after CD19 CART therapy. Presented at: 2022 ASCO Annual Meeting. June 3-7, 2022; Virtual and Chicago, IL. Abstract 7013, Poster 244.