Disparities Associated With CAR-T Therapy Access for Multiple Myeloma Patients

OBJECTIVES: Multiple myeloma (MM) is the second most common hematologic malignancy in the U.S., with Black patients being diagnosed at twice the rate of White patients. Treatment options are limited and ineffective, but CAR-T therapies show promise. However, their high-cost results in disparities in access. This study aims to leverage electronic health records to explore disparities in Multiple Myeloma disease risk and CAR-T therapy access.

METHODS: De-identified data from the University of California Health Data Warehouse (UCHDW) were extracted for patients over 17 years old with an Multiple Myeloma diagnosis and more than one cancer therapy from January 2012 to January 2024 Disease severity was assessed using the International Staging System (ISS) and the number of CRAB symptoms (calcium elevation, renal insufficiency, anemia, and bone abnormalities) per patient. Access to CAR-T therapy was determined by CAR-T treatment initiation. Statistical comparisons were performed using Analysis of variance and logistic regression.

RESULTS: The study included 17,699 patients from the UCHDW, with 245 receiving CAR-T therapy. The mean age of CAR-T patients was 59.3 years, and the mean number of CRAB symptoms was 1.25. Our regression analysis showed significant associations between CAR-T therapy access and Race (p = 0.03), Ethnicity (p = 0.01), UC-Location (p < 0.001), Insurance coverage (p = 0.002), Age (p < 0.001), CRAB symptoms (p < 0.001), and ISS staging (p = 0.05).

CONCLUSIONS: Significant associations were found between disease severity, insurance coverage, baseline demographics, and Multiple Myeloma CAR-T therapy access. Patients with Medicare and more CRAB symptoms were more likely to receive CAR-T therapy. Black patients were 37% less likely, and other races were 38% less likely, to receive CAR-T therapy than White patients. Addressing these disparities is crucial for improving health equity for CAR-T therapies.