Barriers to Stem Cell Transplant in #AML: NC Cohort Insights | Michele Sainvil, MD | #ASH24

Hi, I'm Michelle Sainville and I am a third year hematology oncology fellow at Duke University Medical Center. And I am here to talk about my study on access, improving access to cellular therapy for patients with blood cancers such as multiple myeloma or lymphoma. We did a retrospective study between 2019 and 2022 that was looking at patients in North Carolina diagnosed with a blood cancer. And we wanted to look specifically at patients residing within the 63 counties that we consider part of the Duke catchment area. We wanted to then look at that group of the patients that are eligible for CAR T therapy and those that were already referred to Duke and compare the social factors and the demographics and any systemic factors that might exist to prevent patients from progressing from being referred for being referred for CAR T and actually making it to evaluation and then ultimately getting the infusion. When we compare the patient population that are registered in North Carolina with those that were referred to a tertiary medical center in North Carolina, we found that the patient that was that was already referred, internally referred to our institution. They had higher financial status. They had lower social vulnerability and they also had more private insurance. So there that tells us that we are already missing out on patients from within the community that may not have those factors that may be on Medicare or may be on Medicaid. And that tells us that we need to work harder as a medical community to engage with the with community partners to try to get to provide access to those patients who are not making it to a tertiary care center. We also took the group that was read the group that was referred to Duke and then we broke it down into three different phases. Those who only received a referral, those who made it to initial appointment, and then those who actually went on to receive CAR T therapy. And when we compare the groups for those who were initially referred and received referral only to those that receive an evaluation, we found that race was a barrier. And specifically, we found that black and non-Caucasian patients were less likely to be referred for were less likely to make it to initial evaluation after they had been referred. We also found that patients with Medicare or non-private insurance were also more less likely to make it to initial appointment. And that tells us that we've got some work to do within that area for those that are referred and they are coming to initial appointment. What factors are preventing them from making it to that initial appointment? Insurance is a factor and we find that race is a factor. So targeting the black and non-Caucasian patients and trying to understand what barriers they may be encountering and how we as a medical community can try to mitigate those barriers to make it easier for them. And when we look at the group, the third comparison we did was looking at those groups that received the evaluation, they came to their initial appointment and then those that actually received the CAR-T therapy. And what we found for that group was that patients, female gender as well as female gender and race remain the barrier to receiving CAR-T therapy. And so what that tells us is that there is something, we may not understand what that something is and I think additional research is needed to figure out whether the differences that we're seeing is due to a disparity or something else, but we won't know until we actually look. So the finding tells us that female patients have a harder time receiving transplant even after they've been evaluated at a medical center. And so what that tells us is that maybe we need to get more creative about the ways in which we support our patients. Think about what barriers could potentially be unique to female patients, whether they're primary caregivers, whether there's child care, could we provide child care for their appointments to make it easier for them to make it to appointments? And when we think about race as well, race being a barrier both to get to an appointment and then once having an appointment to actually making it, trying to understand better what the barriers are from a patient's perspective so that we can help make things easier for our patients so that we can make CAR-T, which is a lifesaving treatment, more accessible to patients with blood cancers. Our research is an initial part. It's still ongoing. We are focusing on our institution and there are two other cancer centers that provide CAR-T and transplant within North Carolina. And so looking, our next steps would be to look at those areas, maybe partner with those areas to look at the rest of the patient population to see if we see the same differences in the different institutions. And I think what this tells us as well is that one size fits all is not going to work here because we do know that there are distinct barriers that are preventing patients from moving from one stage to the next. So if we're concerned about the number of patients that are being referred, then we need to go out into the community, partner with community advocacy groups, partner with local oncologists and educate patients about what CAR-T is and why it's important or how it would impact their life or the trajectory of their disease. And we need to also make it accessible for those who are not making it to the, who are not even being referred. That tells us the problem is upstream. And so we need to really focus on community advocacy and community education and partnering with our local oncologists. But for those who actually receive the referral and are having difficulty making it to that appointment, is it a transportation issue? And can we provide financial assistance to help with that transportation? If the issue we are seeing is due to insurance, working with policymakers and to try to broaden insurance coverage so that that is not a barrier to receiving access to therapy. And as I mentioned with female gender being at decreased risk of actually progressing to CAR-T, why is that? I think more doing a prospective study where we are looking at different interventions that could potentially make it easier for patients to make it to appointments, whether it be if we presume it's child care, we can then provide child care during the appointment, during the treatment process. And would that have an impact on whether or not patients are progressing to CAR-T? So I think depending on where we want to focus, and I think that that's one of the reasons why I am passionate about this research because it is the beginning of understanding the bigger picture of what is preventing patients from getting this life-saving treatment and how can we as medical providers, as a medical institution, how can we focus on the patient and then ask how we can make it better for them to get the care that they need.