Equity in Healthcare: Addressing Disparities in CAR T-Cell Therapy Access for Minority Patients with Large B-Cell Lymphomas

A recent study published in March 2024 in NEJM Evidence, led by senior author Marco Ruella, M.D., assistant professor of hematology-oncology at the University of Pennsylvania and scientific director of the lymphoma program, sheds light on disparities in access to CAR T-cell therapy among minority populations being treated for large B-cell lymphomas (LBCL), a type of non-Hodgkin lymphoma.

The study suggests that minority patients may not have equal access to CAR T-cell therapies, despite the potential life-saving benefits they offer.

T-cells are essential for directing immune responses. CAR T-cell therapy involves engineering patients' own immune cells to treat their cancers. T-cells are collected from the patient, modified in a lab to produce chimeric antigen receptors (CARs) on their surface, and then infused back into the patient. The CARs are designed to target and attach to specific proteins on cancer cells.

Since 2017, the FDA has approved six CAR-T therapies for the treatment of blood cancers, including certain types of leukemia, lymphoma and multiple myeloma. CAR-T therapy is highly effective against advanced forms of blood cancer and has been shown to keep the cancer in remission for a long time.

“Our study shows that there might be a limit in access to CAR-T therapy to minority health populations,” Ruella told MHE.

The study analyzed data between 2018 and 2022 from two cancer centers, including Penn Medicine's Abramson Cancer Center in Philadelphia and the Oregon Health and Science University's Knight Cancer Institute in Portland. While the study found equitable access to cancer care for the local community in both locations, the percentage of minority patients who received anti-CD19 CAR T-cell therapy was significantly lower than the percentage treated for LBCL.

“We showed that lymphoma patients in our [Abramson] Cancer Center catchment area include about 18% minority health populations, as defined by the NIH,” Ruella stated. He explained that this percentage of minority health population patients was maintained when the investigators looked at lymphoma patients treated within the Cancer Center with any therapy. “However, the percentage of minority patients dropped significantly (to 7%) when we looked at lymphoma patients who did receive CART19 treatment,” he said

Of note, the researchers observed that the clinical outcomes, including efficacy and toxicity, were similar between minority and non-minority patients, of those who did receive CAR-T therapy.

“These findings held true when we specifically analyzed Hispanic and Latino patients with lymphoma,” Ruella added.

Although the study did not pinpoint the specific causes of these disparities, Ruella suggested that clinical, provider, and socioeconomic factors are likely contributors.

“This is an important observation because it will trigger further studies to understand the possible causes of this disparity,” Ruella explained. “While more population data are needed, we think that socioeconomic factors, possible biases from both the healthcare team and patients, and structural factors drive these results.”

Ruella emphasized the need for further research to understand and address these barriers to ensure that every patient has access to the best possible therapy for their specific cancer type.