Access and Outcomes of CAR-T Cell Therapy in Relapsed/Refractory Multiple Myeloma by Race

Abstract

Background

Multiple myeloma (MM) is a plasma cell malignancy with disproportionately high incidence and mortality among Black patients. Recent advances in CAR-T cell therapies, particularly idecabtagene vicleucel (ide-cel) and ciltacabtagene autoleucel (cilta-cel), have revolutionized treatment for MM. However, administration and supportive care of CAR T cell therapy is complex and disparities in access and outcomes remain poorly characterized in real-world settings.

Methods

We conducted a retrospective cohort study of 101 patients with relapsed/refractory MM (RRMM) treated with CAR-T therapy at Levine Cancer Institute. Baseline patient demographics, treatment and disease characteristics, toxicity, and outcomes were analyzed, with a focus on racial differences.

Results

Median age was 66 years; 58% were male. The cohort was 78% White, 21% Black, and 1% Asian. Black patients comprised 21% of CAR-T recipients, significantly lower than their representation among all MM patients at the center (31%, p = 0.0277). CRS occurred in 79% of patients (86% Black, 77% White). ICANS occurred in 21% of patients (24% Black, 20% White). Neutrophil counts were lower at day 90 for Black vs White patients (median 1.32 vs 2.5 × 106 / L). Infections occurred in 33% of Black and 34% of White patients. MRD negativity was achieved in 86% of Black and 80% of White patients. 6-month progression-free survival was 90% and 82% for Black and non-Black patients, respectively (p = 0.8). The hazard ratio for overall survival between Black and non-Black patients was 1.07 (p = 0.9).

Conclusion

CAR-T therapy yielded similar efficacy and safety outcomes across racial groups. However, Black patients were significantly underrepresented among recipients, despite comparable clinical benefit. These findings highlight the urgent need to address structural and institutional barriers limiting CAR-T access for Black patients with RRMM