OBJECTIVE: CAR T therapy has emerged as an effective therapy for large B-cell lymphoma (LBCL) and may shift the current treatment paradigm. The study objective was to evaluate whether providers performing hematopoietic cell transplantation (HCT), which has been the standard of care, are likely to substitute HCT procedures with CAR T or have higher uptake of CAR T.

METHODS: Data were from the CMS 100% Medicare Fee-for-Service Inpatient and Outpatient files, 2019-2020. Patients receiving CAR T or stem cell transplantation (autologous or allogeneic HCT) were selected for study inclusion. Descriptive statistics were performed, stratified by procedure and year. Trends in utilization were analyzed using Pearson correlation, and logistic regression was used to evaluate likelihood of CAR T uptake.

RESULTS: Between 2019 and 2020, 971 CAR T procedures were performed among 79 providers, and 858 HCT procedures were performed among 131 providers. The mean number of CAR T procedures per provider was 12.3, and the mean number of HCT procedures was 6.5. From 2019 to 2020, the proportion of HCT providers performing at least 1 CAR T procedure increased from 57% to 66%. Uptake of CAR T among HCT centers was significantly correlated with the number of HCT procedures performed: in 2020, for every additional HCT procedure, the likelihood of CAR T procedure increased by 79% (p<0.01). Providers with above average HCT utilization (>6.5) were also more likely to have higher number of CAR T procedures: providers with >6.5 HCT procedures, on average, had 16.1 CAR T procedures between 2019 and 2020; and providers with ≤6.5 HCT procedures had 6.4 CAR T procedures.

CONCLUSION Study findings indicate that providers performing a high number of HCT procedures are more likely to adopt CAR T. Health system investments in new therapies may, in turn, contribute to the adoption of future novel therapies.