CAR-T Access Disparities for Multiple Myeloma in the Midwest: A Social Determinants of Health Perspective.

Background: Multiple Myeloma (MM) is the most common type of blood cancer among black individuals. CAR-T therapy is crucial, but often inaccessible to many black patients and those from underserved communities. The University of Kansas Health System administers over 100 CAR-T treatments annually and aims to evaluate barriers to CAR-T therapy access related to the social determinants of health in the Midwest area.

Methods: This study examined patients with MM referred for CAR-T therapy from January 2021 to December 2023, assessing how race, socioeconomic status, and insurance influenced eligibility for leukapheresis. Data on income and travel were gathered from the 2022 US Census and analyzed using R software.

Results: The study included 271 referrals for MM CAR-T therapy involving 179 patients, with a median age of 66 years (51% male).

Demographics: 80% white, 16% black, 2.2% other races, 1.8% Asian, with a median income of $70,644. Nearly half lived more than 30 min from the center (Mainly from Kansas, Missouri and Nebraska). Apheresis rates were similar across racial groups: 54% for whites, 54% for blacks, and 50% for others, while none of the three Asian patients proceeded. Nine patients (5%) could not proceed because of caregiver or insurance barriers, and cell collection rates were comparable regardless of distance (34% vs. 35%).

Conclusion: This study showed that black representation in CAR-T access matches local demographics, indicating less disparity among minorities. Unlike national reports, distance, income, and insurance do not significantly affect access, suggesting the need for a national study on the social determinants impacting CAR-T access for multiple myeloma.