Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA.
Huntsman Cancer Institute, University of Utah, Division of Hematology and Hematologic Malignancies, Salt Lake City, UT, USA; Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA.
Blood Rev. 2024 Jan;63:101136. doi: 10.1016/j.blre.2023.101136. Epub 2023 Oct 5.
Chimeric antigen receptor T-cell (CAR T-cell) therapy has revolutionized the treatment of hematologic malignancies in patients with relapsed or refractory disease without other treatment options. However, only a very small proportion of patients with an indication for CAR T-cell can access the treatment. The imbalance between supply and demand is magnified in minority and vulnerable populations. Limited access is multifactorial and in part a result of factors directly related to the cellular product such as cost, complex logistics and manufacturing limitations. On the other hand, the impact of diversity, equity, and inclusion (DEI) and their social and structural context are also key to understanding access barriers in cellular therapy and health care in general. CAR T-cell therapy provides us with a new opportunity to better understand and prioritize this gap, a key step towards proactively and strategically addressing access. The aim of this review is to provide an analysis of the current state of access to CAR T therapy with a focus on the influence of DEI. We will cover aspects related to the cellular product and the inseparable context of social and structural determinants. Identifying and addressing barriers is necessary to ensure equitable access to this and all future novel therapies.
嵌合抗原受体 T 细胞（CAR T 细胞）疗法已经彻底改变了复发或难治性疾病且无其他治疗选择的血液系统恶性肿瘤患者的治疗方法。然而，只有极少数有 CAR T 细胞治疗适应证的患者能够获得该治疗。在少数民族和弱势群体中，供需之间的不平衡更加明显。供应有限是多方面的，部分原因是与细胞产品直接相关的因素，如成本、复杂的物流和制造限制。另一方面，多样性、公平性和包容性（DEI）及其社会和结构背景的影响也是理解细胞治疗和一般医疗保健中获取障碍的关键。CAR T 细胞疗法为我们提供了一个更好地理解和优先考虑这一差距的新机会，这是积极和战略性地解决获取问题的关键一步。本综述的目的是分析目前 CAR T 疗法的可及性状况，重点关注 DEI 的影响。我们将涵盖与细胞产品相关的方面以及社会和结构决定因素不可分割的背景。确定和解决障碍对于确保公平获得这种治疗方法和所有未来的新型治疗方法是必要的。
