Toward Equitable Cellular Therapy: Addressing Disparities and Expanding Access to HSCT and CAR T-Cell Therapy

Cellular therapies, such as autologous hematopoietic stem cell transplantation (auto-HSCT), allogeneic HSCT (allo-HSCT), and chimeric antigen receptor (CAR) T-cell therapy, have transformed the field of malignant hematology, offering curative and life-extending potential that was never previously available.Yet despite these therapeutic advances, persistent disparities in access by race, ethnicity, socioeconomic status, geography, and practice setting block the equitable delivery of these therapies.Black and Hispanic patients remain significantly less likely to receive auto-HSCT for multiple myeloma, even after referral to transplant centers.Under-representation of racial and ethnic minorities in donor registries has historically limited access to allo-HSCT, though the advent of post-transplant cyclophosphamide (PTCy)-based platforms and haploidentical donors is reshaping this landscape.CAR T-cell therapy, which primarily occurs at large academic medical centers, imposes geographic, logistical, and financial burdens that disproportionately affect underserved populations.This review evaluates the multilevel barriers to HSCT and cellular therapy access, highlights recent advances in the field, and proposes actionable strategies at the patient, provider, system, and policy levels to advance equity in cellular therapy delivery.binaytara.org/