Disparity in access to multiple myeloma CAR-T: a geospatial analysis of distance to CAR-T centers

This is the authors' abstract. We don't add key points for this paper.

Immune therapy with chimeric antigen receptor T (CAR-T) cells has greatly improved outcomes in multiple myeloma patients, promoting deep and durable remissions in heavily pretreated patients and moving closer to an elusive cure for this disease. While CAR-T therapies hold great promise, they come at significant cost and require a specialized manufacturing process. We hypothesized that given the vast size and variable distribution of population across the United States, large portions of the country would be significantly removed from a CAR-T center, limiting these patients’ access to CAR-T centers and interacting with other social determinants of health to exacerbate health care disparities in multiple myeloma. Using a unique geospatial analysis, we show that the mostly urban and academic CAR-T cell centers are hours away from large portions of the US, including traditionally underserved areas such as Appalachia and the Deep South. People in these regions were more likely to be on average socioeconomically disadvantaged, as evidenced by higher scores on the CDC Social vulnerability index, and therefore this population may face greater barriers to traveling to CAR-T centers. Our study suggests a deepening divide between multiple myeloma care at large academic CAR-T centers and community oncology centers. This disparity may be rationally addressed with social resources such as improved insurance reimbursement that includes coverage for travel and lodging support, development of next-generation CAR-T manufacturing platforms more easily translated to the community center, and continued development of treatment options with small molecules and biologics more readily available at smaller centers.