Weise Michael, Atrash Shebli, Ansari Briha, Mushtaq Muhammad Umair, McGuirk Joseph, Abdallah Al-Ola, Mahmoudjafari Zahra, Ahmed Nausheen
Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS 66205, USA.
Levine Cancer Institute, Atrium Health Wake Forest University School of Medicine, Charlotte, NC 28204, USA.
Curr Oncol. 2025 Sep 3;32(9):495. doi: 10.3390/curroncol32090495.
Multiple Myeloma (MM) is the most common type of blood cancer among black individuals. CAR-T therapy is crucial, but often inaccessible to many black patients and those from underserved communities. The University of Kansas Health System administers over 100 CAR-T treatments annually and aims to evaluate barriers to CAR-T therapy access related to the social determinants of health in the Midwest area.
This study examined patients with MM referred for CAR-T therapy from January 2021 to December 2023, assessing how race, socioeconomic status, and insurance influenced eligibility for leukapheresis. Data on income and travel were gathered from the 2022 US Census and analyzed using R software.
The study included 271 referrals for MM CAR-T therapy involving 179 patients, with a median age of 66 years (51% male).
80% white, 16% black, 2.2% other races, 1.8% Asian, with a median income of $70,644. Nearly half lived more than 30 min from the center (Mainly from Kansas, Missouri and Nebraska). Apheresis rates were similar across racial groups: 54% for whites, 54% for blacks, and 50% for others, while none of the three Asian patients proceeded. Nine patients (5%) could not proceed because of caregiver or insurance barriers, and cell collection rates were comparable regardless of distance (34% vs. 35%).
This study showed that black representation in CAR-T access matches local demographics, indicating less disparity among minorities. Unlike national reports, distance, income, and insurance do not significantly affect access, suggesting the need for a national study on the social determinants impacting CAR-T access for multiple myeloma.
多发性骨髓瘤（MM）是黑人中最常见的血癌类型。嵌合抗原受体T细胞（CAR-T）疗法至关重要，但许多黑人患者以及来自服务不足社区的患者往往无法获得该疗法。堪萨斯大学健康系统每年进行超过100例CAR-T治疗，并旨在评估中西部地区与健康的社会决定因素相关的CAR-T治疗获取障碍。
本研究调查了2021年1月至2023年12月转诊接受CAR-T治疗的MM患者，评估种族、社会经济地位和保险如何影响白细胞分离术的资格。从2022年美国人口普查中收集收入和出行数据，并使用R软件进行分析。
该研究纳入了271例MM CAR-T治疗转诊病例，涉及179名患者，中位年龄为66岁（51%为男性）。
80%为白人，16%为黑人，2.2%为其他种族，1.8%为亚洲人，中位收入为70,644美元。近一半患者居住在距离中心超过30分钟路程的地方（主要来自堪萨斯州、密苏里州和内布拉斯加州）。各种族的单采率相似：白人54%，黑人54%，其他种族50%，而三名亚洲患者均未进行。9名患者（5%）因护理人员或保险障碍无法进行，细胞采集率与距离无关（分别为34%和35%）。
本研究表明，CAR-T治疗获取中的黑人比例与当地人口统计数据相符，表明少数族裔之间的差异较小。与全国报告不同，距离、收入和保险对获取没有显著影响，这表明需要对影响MM患者CAR-T治疗获取的社会决定因素进行全国性研究。
