06 January 2022

3 minutes to read


Hall AG, et al. Abstract 339. Presented at: ASH Annual Meeting and Exposition; December 11-14, 2021; Atlanta.

Disclosures: Hall does not report any relevant financial disclosures. Please see the summary for all relevant financial information from other researchers.

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Younger Hispanic / Latinx patients face many barriers that may limit timely access to chimeric antigen receptor T cell therapy trials for acute lymphoblastic leukemia, retrospective study results relapsed or refractory B cells.

The results – presented at the annual ASH meeting and exhibition – showed that young patients referred to urban academic centers for CAR-T clinical trials were more often non-Hispanic / Latin Caucasian, spoke English. and generally traveled 40 times farther than locally referred patients.

Distance traveled to the CAR-T center.
Data derived from Hall AG, et al. Abstract 339. Presented at: ASH Annual Meeting and Exposition; December 11-14, 2021; Atlanta.

“CAR T cells have revolutionized the treatment of relapsed acute lymphoblastic B-cell leukemia, but patients may face additional barriers when accessing these therapies,” Anurekha Hall, MD, MS, acting instructor at Seattle Children’s Hospital and the Clinical Research Division at the University of Washington and the Fred Hutchinson Cancer Research Center, Healio said.

There is a wealth of information on the racial, ethnic, and socioeconomic disparities associated with participation in pediatric clinical trials and patient outcomes, but these factors have yet to be assessed for patients participating in CAR cell therapy trials. T, Hall added.

Anurekha Hall, MD, MS

Anurekha room

“Our results suggest that access barriers, such as distance and the need to travel, may have a different impact on Hispanic patients,” she told Healio. In addition, Spanish-speaking patients and patients with public insurance were also under-represented in referrals from outside institutions, suggesting that language and confidence may also be key barriers to access. “

Hall and colleagues conducted a retrospective, multicenter cohort study of children and young adults with B-cell ALL treated between 2012 and 2018 within the Consortium for Pediatric Cellular Immunotherapy, which includes Seattle Children’s Hospital, Children’s National, Children’s Hospital Colorado, Children’s Hospital Los Angeles, and UCSF Benioff Children’s Hospitals.

Investigators collected clinical and demographic data from electronic patient health records. The researchers also assigned the patients a socioeconomic score using data from the US Census.

The cohort consisted of 1374 patients aged 27 years or younger with B-cell ALL, 27% of whom had relapsed or refractory disease. The cohort included patients with relapsed or refractory disease who had been referred to a study center for CAR-T from either inside (n = 80) or outside (n = 142) of the establishment, in addition to those with relapse or refractory disease not referred for CAR-T (n = 150) or local patients without relapse or refractory disease (n = 1002).

Patients referred for CAR-T to one of the participating centers traveled an average of 824 miles from their homes to receive their therapy, compared to 20.5 miles among local CAR-T beneficiaries.

The CAR-T local beneficiary group included a higher percentage of Hispanic / Latinx patients than the outpatient referral group (56% vs. 29%; P

A significantly higher proportion of local CAR-T beneficiaries than referred patients had public insurance (65% vs. 31%; P

Researchers reported similar average socioeconomic scores across all patient subgroups. The researchers found the finding “surprising”, according to Hall, given its known association with participation in clinical trials and the results of other pediatric cancer studies.

Since all of the CAR-T centers included in the analysis are in urban areas with Hispanic / Latin populations above the national average, local demographics likely had an effect on the ethnic makeup of local CAR-T patients. in this study, Hall said.

“However, in the three largest centers, the proportion of Hispanic patients who received local CAR-T appeared to be greater than the proportion of Hispanic patients in the referred CAR-T cohort, suggesting that this may be. -being of a more generalized phenomenon, ”she added. .

The findings highlight the significant barriers non-local patients face when referred for CAR T cell therapy and suggest that these burdens may disproportionately affect younger Hispanic / Latin patients located outside of urban centers, a. Hall said.

“Non-local CAR-T patients often travel very long distances to access these trials, further emphasizing that trips to trials can place a significant burden on families,” Hall told Healio. “Traveling to receive CAR-T cell therapy can be resource intensive and not possible for all families. Ultimately, it will be important to provide these life-saving therapies closer to home to allow more children to access them. “