Sociodemographic disparities and clinical outcomes in chimeric antigen receptor (CAR) T-cell therapy: A real-world study at a diverse academic cancer center.

e23435 Background: Chimeric Antigen Receptor T-cell (CAR-T) therapy is an effective treatment for relapsed/refractory hematologic malignancies. However, disparities in access, toxicity burden, and outcomes may exist for patients from minoritized and underserved backgrounds. This study evaluated real-world CAR-T therapy outcomes at a single academic cancer center, focusing on socioeconomic and demographic predictors of treatment response and toxicity. Methods: We performed a retrospective cohort study of 101 adult patients who received commercial CAR-T therapy (axicabtagene ciloleucel, brexucabtagene autoleucel, ciltacabtagene autoleucel) at USC Norris Comprehensive Cancer Center between 2022–2025. Demographic, geographic, clinical, and treatment-related variables were extracted from REDCap. Multivariable logistic regression and chi-square/Fisher’s exact tests were used to assess associations between sociodemographic variables—including race/ethnicity, insurance status, Social Vulnerability Index (SVI), and distance from the transplant center—and key outcomes: treatment response, toxicity (CRS/ICANS), ICU admission, and delays to infusion. Results: The cohort had a median age of 62 years; 63% were male and 38% identified as Hispanic. Diffuse Large B-Cell Lymphoma (DLBCL) (44%) was the most common diagnosis, followed by Multiple Myeloma (22%) and Acute Lymphoblastic Leukemia (ALL) (21%). Insurance coverage included commercial (49%), Medicare (27%), and Medicaid (23%). In multivariable analyses, female sex was significantly associated with lower odds of achieving a treatment response compared to males (OR 6.69 for males, p = 0.038). Public insurance (Medicare or Medicaid) was associated with increased risk of severe neurotoxicity (ICANS grade ≥3, p = 0.012) and ICU admission ( p = 0.035). DLBCL diagnosis was significantly associated with reduced odds of response ( p < 0.05), highlighting disease-specific variation in CAR-T efficacy. No statistically significant associations were found between outcomes and SVI, race/ethnicity, or distance to the transplant center. Time from referral to infusion also did not significantly differ by ethnicity, insurance type, or SVI quartile. Conclusions: In this single-center cohort, female patients and those with DLBCL had significantly lower odds of response to CAR-T therapy. Public insurance was associated with higher neurotoxicity and ICU utilization. These findings underscore potential disparities in CAR-T outcomes based on sex, insurance status, and disease subtype, even within an academic setting. Larger, multi-center studies are warranted to confirm these associations and inform equity-focused strategies in cellular therapy delivery.