Disparities in Access to CAR-T Therapy in US Patients with LBCL After ≥2 Prior Lines of Therapy

There is limited evidence on whether disparities in access to chimeric antigen receptor T-cell (CAR-T) therapy exist in patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL). Results from a study examining and contextualizing determinants of CAR-T therapy receipt and disparities in access among patients with R/R DLBCL enrolled in US Medicare Fee-For-Service (FFS) with ≥2 failed prior lines of therapy (LOTs) and who were actively treated with subsequent LOTs were reported at the 64th American Society of Hematology Annual Meeting and Exposition.

Patients in this retrospective cohort were identified from January 2017 through March 2021 using the Medicare Limited Data Set administrative claims data containing 100% final action claims submitted for Medicare FFS beneficiaries. Claims data were linked to publicly available US census county-level measures of the Area Deprivation Index (ADI) 2019, as well as predisposing, enabling, and need-contextual characteristics from the Area Health Resource Files from 2019 to 2020 to measure socioeconomic disadvantage. Patients ≥18 years of age with newly diagnosed DLBCL continuously enrolled for ≥6 months before diagnosis and who received ≥2 prior LOTs, including chemoimmunotherapy, during follow-up were included. Patients with prior diagnoses of other non-Hodgkin lymphomas or hematologic cancers were excluded, except for primary mediastinal LBCL, chronic lymphocytic leukemia, and follicular lymphoma. Statistical analyses included 3 models: bivariate unadjusted, multivariate with ADI adjusted, and multivariate with select county-level characteristics adjusted.

Of 15,472 Medicare patients with DLBCL who received rituximab at any point during follow-up, 266 patients had 2 prior LOTs, rituximab in combination with another chemotherapy as first-line therapy, and a third or later LOT that was an active comparator of interest; 104 patients received CAR-T therapy and 162 patients did not. More CAR-T therapy recipients were evaluated for clinical trial participation over the study period versus non-recipients (37.5% vs 11.1%, P <.01). In a bivariate unadjusted analysis, patients ≥76 years of age were associated with lower odds of receiving CAR-T therapy (odds ratio [OR], 0.386; P = .003). In a multivariate with ADI-adjusted analysis, CAR-T therapy recipients were less likely to be female (OR, 0.521; P = .040) or ≥76 years (OR, 0.349; P = .004). In a multivariate with select county-level characteristics-adjusted analysis, CAR-T therapy recipients were less likely to be female (OR, 0.513; P = .033) or ≥76 years (OR, 0.444; P = .026). In an adjusted analysis of 209 patients (excluding those evaluated for clinical trial participation), CAR-T therapy recipients were less likely to be female, have a Charlson Comorbidity Index score of ≥3, or be residents of the US South. There were no associations between socioeconomic disadvantage and receipt of CAR-T therapy.

Despite the small sample size, these findings suggest that access to CAR-T therapy needs particular improvement in female patients and patients living in the South, possibly due to geographical limitations of centers that offer CAR-T therapy. Increased adoption of CAR-T therapy can have a significant impact on patients’ lives, empowering the pursuit for increased access to therapies among underserved communities.

Source

Saunders A, Inguva S, Keating SJ, Chirikov V. Examination of disparities in access to chimeric antigen receptor T cell therapies in Medicare patients with relapsed or refractory diffuse large B-cell lymphoma who had failed at least 2 prior lines of therapy. Presented at: 64th American Society of Hematology Annual Meeting and Exposition, December 10-13, 2022; New Orleans, LA. Poster presentation 4906.

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