美国复发/难治性 DLBCL 患者 CAR-T 细胞治疗可及性的不平等：一项 SEER-Medicare 数据分析

Chimeric antigen receptor (CAR) T-cell (CAR-T) therapy has shown curative potential for patients with diffuse large B-cell lymphoma (DLBCL) and other malignancies, but its accessibility among Medicare patients, particularly in disadvantaged populations, remains uncertain.

This study aims to assess CAR-T use among Medicare patients with DLBCL receiving third-line or later (3L+) treatment, focusing on access disparities and their impact on clinical outcomes. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2007 to 2020, multivariate logistic regression was used to evaluate patient characteristics and the effects of distance to authorized treatment centers (ATCs) on CAR-T access. Between 2017 and 2020, 2241 patients were treated for 3L+ DLBCL in the SEER-Medicare data, of whom 122 (5.

4%) received CAR-Ts. CAR-T recipients were less likely to have multiple comorbidities (odds ratio [OR], 0. 904; P = . 001) but more likely to live in higher income areas (OR, 1. 176; P = . 004). If distance to the nearest ATC for "poor-access" states (average distance to ATC, 104. 4 miles) decreased to the average distance in "better-access" states (34. 2 miles), there would be a 37. 6% increase in number of patients receiving CAR-Ts (6. 6%-9. 1%; P < . 001).

These findings highlight substantial disparities in CAR-T use, driven by geographic and socioeconomic factors. Addressing these barriers could significantly enhance equitable access to CAR-T therapy and improve outcomes for underserved populations, emphasizing the need for targeted interventions to reduce geographic and systemic barriers to care.