Minority Access & Outcomes with Anti-BCMA CAR T Therapy in Myeloma

Good morning, I'm Luca Paruzzo, Pox Doctoral Fellow at the University of Pennsylvania. Today I'm going to explain my work about establish equitable access to CAR-T immunotherapy. Multiple myeloma is a methodological cause that significantly burden minority health population. Indeed, more than 20% of the patient belongs to minority health population. In our study, we define minority health population according to the US Office of Management and Budget definition of minority health population. When we think about minority health population, we need to know that they represent a significant proportion of patients. However, they are often underrepresented in clinical trials and they have often difficulties to access even standard therapies such as autologous tensile transplantation or tribal therapies. Nowadays we have a new pillar of treatment. We are using immunotherapy to fight myeloma. We have Bispecifut and CAR-T. CAR-T we can think about it like immune cells that are making powerful to specifically recognize a target on the myeloma cells. CAR-T are super effective. We have two approved CAR-T products and we have thousands of patients treated every year around the world. However, even if they are very effective, they have specific logistic challenges that might compromise their access to this data. First of all, just over 100 CAR-T centers around the United States. So patients need to travel to reach the closest CAR-T center. Indeed, a study done by Snyder et al. showed that in average, a CAR-T patient needs to travel more than one hour to reach the closest CAR-T treatment. For that reason, we decided to analyze if at our center, the University of Pennsylvania, the Amazon Cancer Center, minority health population have equitable access to CAR-T immunotherapy. To do that, we consider three populations. First of all, we analyze the proportion of minority health population in our catchment area. When we think about catchment area, 12 counties around Penn that provide more, more, more than 80% of the patients to this case. Then we consider the proportion of minority health population that are treated at Penn that receive any type of treatment and we use a temporal cutoff between June 2021 and October 2023. And finally, we analyze a third cohort, the CAR-T BCMA cohort. Again, patients that don't see CAR-T between June 2021 and October 2023. And what we saw that there was a decrease of minority health population representation from the catchment area to the CAR-T cohort. They go from 33% to 18%, so a significant drop. However, in our analysis, we start to think Penn is a tertiary center, so every patient can be referred from outside the institution. So we stratify to see how those patients coming from inside the catchment area or outside the catchment area. And what we saw that when we consider that inside the catchment area, there is a decrease, we go from 33% to 24%, is a significant decrease, but the population is still preserved. But when we look to the outside catchment area, only less than 10% of the patient is minority health population. Considering only all the logistical challenge that the patient might face, including the need to travel, the presence of a caregiver, and the fact that they need to stay near to the hospital for a month, we try to analyze where our patients live and if their ability to travel might matter. And when we analyze the time of travel from the resident to the patient to the CAR-T, what we found is that non-minority health population actually travel longer, and that suggests that they have more abilities to overcome this bias. Another important fact is that when minority health population access CAR-T treatment, they have the same similar outcome in terms of response rate, toxicities, and long-term control disease. Therefore, we need to find a way to establish equitable access to CAR-T monotel for all the population. This can be to support travel expense, to find a way to overcome logistic challenge, but this is important because all the people need to access this treatment.