Access to chimeric antigen T-cell receptor (CAR-T) therapy for patients with Non-Hodgkin Lymphoma (NHL) in Oregon

NHL is the eight most common cancer in the U.S. and exhibits poor survival, particularly among patients with disease resistant to conventional chemotherapy. While CAR-T therapies are now available for patients with advanced disease, access to these agents is inequitable. In this retrospective study, we identified baseline demographic and socioeconomic factors of NHL patients treated with CAR-T therapies at our institution.

Adult patients with B-cell NHL referred to the OHSU Knight Center for Hematologic Malignancies for CAR-T therapy between Jan 2016 and May 2023 were included. Data collected included age, gender, race/ethnicity, zip-code, insurance type, disease type and status at time of treatment and clinical trial participation. Zip-codes were used to calculate area deprivation index (ADI), rural-urban continuum codes and distance from the treatment center.

154 patients with a median age of 63.4 years (range, 23.5-81.6 years) underwent CAR-T therapy for B-cell NHL with 4 commercial (86%) and 6 investigational products (14%). 42.9% of patients were older than 65 years, 67.5% male and 86.4% white, non-Hispanic. Approximately 66% of those younger than 65 were privately insured, while 87% of those over 65 had Medicare. 16% of patients came from areas with a high ADI index (most disadvantaged) and 1.3% from rural areas, with 26.6% coming from areas more than 120 miles away for the treatment center. Of the 22 participants in clinical trials, 59% were males, 27% older than 65, 46% had public insurance, 46% lived in areas with high ADI and 9% were from rural settings.

Although CAR-T treatment access may vary by region, OHSU has been able to offer this therapy to patients in Oregon from socioeconomically diverse backgrounds. Our study highlights the importance of identifying social determinants of health when implementing CAR-T therapy programs to optimize access to all patients in need.