Neighborhood socioeconomic disadvantage and distance from treatment center do not impact survival outcomes of patients with non-Hodgkin’s lymphoma and Multiple Myeloma treated with CAR T-cell therapies.

Chimeric antigen receptor (CAR) T-cell therapies are potentially curative for relapsed/refractory (r/r) hematologic malignancies. Health disparities, including neighborhood-level socioeconomic (SE) disadvantage, have been linked to adverse outcomes in other settings but remain understudied in CAR T-cell recipients. We evaluated the impact of neighborhood SE status and distance to treatment center (DTC) on outcomes in patients with non-Hodgkin's lymphoma (NHL) and multiple myeloma (MM) treated with CAR T-cell therapy.

We retrospectively reviewed adults with r/r B-cell NHL and MM who received CAR T-cell therapy at our center (May 2018–Jan 2023). Neighborhood disadvantage was quantified using the Area Deprivation Index (ADI; percentile rank 1–100, higher = more disadvantaged). ADI and DTC were stratified by median values (62.5 and 42.5 miles, respectively). Primary endpoints were overall survival (OS) and progression-free survival (PFS), analyzed by Kaplan-Meier and Cox regression.

We included 124 NHL and 45 MM patients (median age 65 and 62 years). Most were White (94% NHL, 84% MM) and from Ohio (89%). Median ADI was 62.5; median DTC was 42.5 miles. For the entire study population, median ADI rank was 62.5 (range 1-100) and median DTC was 42.5 (range 1-4559) miles. Pts. were categorized as having high (> 62.5) or low (≤ 62.5) ADI, and long (> 42.5m) or short (≤ 42.5m) DTC. Longer DTC was associated with higher ADI (p<0.001). Baseline characteristics were similar across ADI and DTC groups. Median follow-up was 12 months (NHL) and 9 months (MM). Median duration of follow up was 12 (range 0-60) and 9 (range 0-22) months for pts. with B-NHL and MM, respectively. For pts. with B-NHL, objective response rates (ORR) (85% vs. 80%; p=0.4), relapse rates (RR) (66% vs. 66%; p=0.9), median OS (19 vs. 14 months; HR of death: 1.2; 95% CI 0.7-1.8; p=0.5) (Fig.1), and median PFS (10 vs. 5 months, HR of relapse: 1.1, 95% CI 0.7-1.7; p=0.6) were similar for pts. with low vs. high ADI. For pts. with MM, there were no differences in ORR (77% vs. 87%; p=0.3), RR (77% vs. 70%; p=0.5), median OS (14 vs. 18 months; HR of death: 0.8; 95% CI: 0.3-2; p=0.6) (Fig.2), and median PFS (7 vs. 9 months, HR of relapse: 0.7, 95% CI 0.3-1.4; p=0.3) between those with low vs. high ADI. DTC was not associated with OS in NHL or MM.

In this single-center cohort, neighborhood disadvantage and distance from treatment center did not impact survival or response to CAR T-cell therapy in NHL or MM, though patients from disadvantaged areas traveled farther. Multicenter studies are needed to validate these findings.