Impact of race and social determinants of health on outcomes in patients with aggressive B-cell NHL treated with CAR-T therapy
Reem Karmali, Rushad Machhi, Narendranath Epperla, Geoffrey Shouse, Jason T. Romancik, Tamara K. Moyo, Vaishalee P. Kenkre, Thomas Ollila, Lindsey Fitzgerald, Brian Hess, Kevin A. David, Ishan Roy, Joanna Zurko, Sayan Mullick Chowdhury, Kaitlin Annunzio, Robert Ferdman, Rahul S. Bhansali, Elyse I. Harris, Jieqi Liu, Imran Nizamuddin, Shuo Ma, Jonathan Moreira, Jane N. Winter, Barbara Pro, Deborah M. Stephens, Alexey V. Danilov, Nirav N. Shah, Jonathon B. Cohen, Stefan K. Barta, Pallawi Torka, Leo I. Gordon
Abstract
ABSTRACT: Chimeric antigen receptor (CAR) T-cell (CAR-T) immunotherapy is an effective therapy for relapsed/refractory B-cell non-Hodgkin lymphoma (r/r B-NHL). However, data are limited on the impact of the convergence of race and social determinants of health on outcomes for patients treated with CAR-T therapy. We examined the impact of interactions between race and insurance type on health care use and outcomes in patients treated with CAR-T therapy for aggressive B-NHL. Adult patients with r/r B-NHL treated with CD19 CAR-Ts were identified between 2015 and 2021 across 13 US academic centers. Insurance type, demographic, and clinical data were collected and analyzed. In total, 466 adult patients were included in our analysis. Median follow-up after CAR-T therapy was 12.7 months. Median progression-free survival (mPFS) was longer for Caucasians (11.5 months) than for African Americans (3.5 months; hazard ratio [HR], 1.56 [1.03-2.4]; P = .04) or Asians (2.7 months; HR, 1.7 [1.02-2.67]; P = .04). Differences in median overall survival (mOS) were not significant. For Medicare (n = 206) vs Medicaid (n = 33) vs private insurance (n = 219) vs self-pay (n = 7): mPFS was 15.9 vs 4.2 vs 6.0 vs 0.9 months (P < .001), respectively; and mOS was 31.2 vs 12.8 vs 21.5 vs 3.2 months (P < .001), respectively. Our multicenter retrospective analysis showed that race and insurance status can affect outcomes for patients treated with CAR-T therapy.