社区社会经济劣势与至治疗中心的距离不影响接受 CAR-T 细胞治疗的非霍奇金淋巴瘤和多发性骨髓瘤患者的生存结局

Chimeric antigen receptor (CAR) T-cell therapies have transformed the treatment of relapsed/refractory (r/r) hematologic malignancies but are largely delivered at specialized academic centers. Socioeconomic and geographic factors may influence access to these therapies and potentially impact outcomes. While neighborhood disadvantage has been associated with worse health outcomes, its impact on survival following CAR T-cell therapy remains unclear.

We conducted a retrospective study of adult patients with r/r B-cell non-Hodgkin lymphoma (B-NHL) and multiple myeloma (MM) treated with CAR T-cell therapy at a single academic center. Neighborhood socioeconomic disadvantage was assessed using the Area Deprivation Index (ADI), with higher scores indicating greater disadvantage. Distance to treatment center (DTC) was calculated from patient residence.

Overall survival (OS) and progression-free survival (PFS) were compared by ADI and DTC using Kaplan-Meier estimates and Cox proportional hazards models. A total of 124 B-NHL and 45 MM patients received CAR T-cell therapy between 2018 and 2023. Median ADI was 62. 5 and median DTC was 42. 5 miles. Longer DTC was associated with higher ADI (P < . 001). No significant differences in OS, PFS, or response rates were observed between high- and low-ADI groups for either B-NHL (median OS: 19 versus 14 mo; P = . 50) or MM (median OS: 14 versus 18 mo; P = . 60). Similarly, survival did not differ between patients with long versus short DTC for B-NHL (median OS: 19 versus 14 mo; P = .

40) or MM (median OS: 14 versus 20 mo; P = . 90). Dichotomizing ADI into the highest 15% versus lower 85% also showed no impact on outcomes. In this single-center cohort of patients who received CAR T-cell therapy, neighborhood disadvantage and distance to the treatment center were not associated with differences in survival outcomes.

Although selection and referral biases likely influence which patients ultimately receive therapy, these findings suggest that once access to CAR T-cell therapy is achieved, outcomes may be comparable across socioeconomic and geographic groups. Improving equitable referral pathways and access to specialized centers remains essential.