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4922 Impact of Race and Social Determinants of Health on Outcomes in Patients with Aggressive B-Cell Lymphomas Treated with Chimeric Antigen Receptor T-Cell (CART) Therapy

Program: Oral and Poster Abstracts
Session: 905. Outcomes Research—Lymphoid Malignancies: Poster III
Hematology Disease Topics & Pathways:
Research, Biological therapies, Clinical Research, health outcomes research, Chimeric Antigen Receptor (CAR)-T Cell Therapies, health disparities research, real-world evidence, Therapies
Monday, December 12, 2022, 6:00 PM-8:00 PM

Reem Karmali, MD, MSc1, Narendranath Epperla, MD, MS2, Geoffrey Shouse, PhD, DO3, Jason T. Romancik, MD4, Tamara K. Moyo, MD, PhD5*, Vaishalee P. Kenkre, MD6, Thomas A. Ollila, MD7, Lindsey A. Fitzgerald, MD8, Brian T. Hess, MD9, Andrew M. Evens, DO, MBA, MMSc10, Ishan Roy11*, Joanna Zurko, MD12, Sayan Mullick Chowdhury, DO, PhD13*, Kaitlin Annunzio, DO14, Robert Ferdman, MD15*, Rahul Bhansali, MD16*, Elyse I. Harris, MD17, McKenzie Sorrell, DO9, Jieqi Liu, MD18, Imran A. Nizamuddin, MD19, Shuo Ma, MD20, Jonathan Moreira, MD21, Jane N. Winter, MD22, Barbara Pro, MD22,23, Deborah M. Stephens, DO24, Alexey V Danilov, MD25, Nirav N. Shah, MD26, Jonathon B. Cohen, MD, MS27, Stefan K. Barta, MD28, Pallawi Torka, MD15 and Leo I. Gordon, MD21

1Robert H. Lurie Comprehensive Cancer Center, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
2The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
3Department of Hematology/HCT, City of Hope National Medical Center, Duarte, CA
4Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, GA
5Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
6Carbone Cancer Center, University of Wisconsin, Madison, WI
7Lifespan Cancer Institute, Brown University, Providence, RI
8Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
9Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
10Rutgers Cancer Institute of New Jersey, Warren, NJ
11Northwestern University, Chicago, IL
12University of Wisconsin, Madison, WI
13Ohio State University Medical Center, Columbus, OH
14The Ohio State University, Columbus, OH
15Roswell Park Comprehensive Cancer Center, Buffalo, NY
16Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
17Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI
18Rutgers Cancer Institute of New Jersey, Hoboken, NJ
19Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
20Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
21Department of Medicine, Division of Hematology/Oncology and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Northwestern University Feinberg School of Medicine, Chicago, IL
22Division of Hematology and Oncology, Northwestern University, Chicago, IL
23Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
24Huntsman Cancer Institute, Salt Lake City, UT
25Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
26Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI
27Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
28Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA


Health care disparities, driven by multiple social, economic, and/or environmental factors lead to inequalities in health outcomes. With CAR T-cell therapy (CART), differences in response rates have been identified across race. However, data that address the convergence of race with other social determinants of health on outcomes with CART remain limited. We examined the impact of interactions between race, insurance status, clinical trial utilization, and age on access to care and outcomes in patients (pts) treated with CART for aggressive B-cell lymphomas (B-NHL).


Adult pts with relapsed/refractory B-NHL treated with CD19 CART between 2015- 2021 across 13 US academic centers were identified. Insurance type, demographic and clinical data were collected and analyzed via Chi-squared and Kaplan-Meier analysis. Cox multivariable regression was used to determine impact of race/ethnicity and other variables on survival. Variables used in the multivariable analysis (MVA) included race, age, insurance type, prior autologous stem cell transplantation (autoSCT), CART on clinical trial, use of bridging therapy, IPI at CART infusion, and elevated LDH pre-CART. Race (Caucasian, African American (AA), Asian or Other with the latter cohort excluded from analyses) and ethnicity (Hispanic vs non-Hispanic) were self-reported by pts.


A total of 466 adult pts were included. Table 1 outlines demographic, clinical, and health care utilization parameters by race. 406 (87%) were Caucasian, 34 (7%) AA and 26 (6%) Asian; 9 (2%) were Hispanic (all Caucasian). Caucasians were older compared to AAs and Asians (median age 59 vs 55 vs 55 yrs; p=0.004). Median number of lines of therapy prior to CART were similar across race (p=0.44). Caucasians were more likely to have a prior autoSCT (p= 0.04). For Caucasians vs AAs vs Asians: rates of bridging were 44% vs 61% vs 46% (p=0.17) and rates of utilization of clinical trials for CART access were 29% vs 15% vs 19% (p=0.12), respectively. Median time from last relapse/progression pre-CART to CART was 2 vs 1.8 vs 1.2 mo (p=0.9) and median time from apheresis to CART was 1.1 vs 1.1 vs 0.9 mo (p=0.2), respectively. D180 ORR were 51% vs 46% vs 19% (p =0.01) with D180 CR rates of 43% vs 42% vs 19% (p = 0.17), respectively. No difference in grade >/= 3 CRS or ICANS was observed across race.

Median follow-up after CART was 12.7 mo. Median PFS (mPFS) was longer for Caucasians (11.5 mo) than for AAs (3.5 mo, HR 1.56 [1.03-2.4], p=0.04) or Asians (2.7 mo, HR 1.7 [1.02-2.67], p=0.04). Differences in median OS (mOS) were not statistically different: mOS was 25.4 mo in Caucasians vs 30.4 mo in AAs (HR 1.0 [0.59 – 1.69], p=0.99) vs 16.8 mo in Asians (HR 1.42 [0.84 – 2.42], p=0.19).

Rates for administration of therapy after CART failure were non-significantly higher for Caucasians vs AAs or Asians, (46% vs 25% vs 28%, p = 0.05). On MVA, race, insurance type, use of bridging, and elevated LDH pre-CART impacted PFS (p < 0.001 – 0.031, Table 2). As compared to Caucasians, AAs (but not Asians) had a worse PFS (HR 1.72 [1.05 – 2.82], p = 0.03). Race did not impact OS. Medicare, lack of bridging, and receipt of further therapy post CART failure positively impacted OS (p = 0.006 - 0.044).

Insurance type did not impact median time from last relapse/progression to CART. However, there were significant differences in mPFS and mOS between payer groups: mPFS was 15.9 vs 4.2 vs 6.0 vs 0.9 mo (p<0.001) and mOS was 31.2 vs 12.8 vs 21.5 vs 3.2 mo (p<0.001) for Medicare (n=206) vs Medicaid (n=33) vs private insurance (n=219) vs self-pay (n=7).


In our cohort, AAs and Hispanics were greatly underrepresented which underscores the presence of health care disparities across race and ethnicity for relapsed/refractory B-NHL. With CART, Caucasians had similar complete response rates but longer mPFS as compared to AAs and Asians warranting exploration of factors that may predict for early progression in racial minorities. No difference in OS was observed by race perhaps attributed to the effects of next line therapy after CART. Insurance type impacted both PFS and OS with best outcomes seen in pts with Medicare. Results do not capture pts facing insurance denial and/or poor access that would likely augment trends for race and socioeconomic disparities identified in our CART population. The interaction between race and insurance status and their relative contributions to access and outcomes with CART should be further explored.

Disclosures: Karmali: Takeda: Research Funding; Calithera: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Advisory Board; Genentech/Roche: Consultancy, Other: Advisory Board; Pharmacyclics: Consultancy, Other: Advisory Board; BMS/Celgene: Consultancy, Research Funding; Morphosys/Incyte: Consultancy, Other: Advisory Board, Speakers Bureau; AstraZeneca: Other: Advisory Board, Speakers Bureau; Kite: Consultancy, Other: Advisory Board, Research Funding, Speakers Bureau; Karyopharm: Consultancy; Eusa: Consultancy; BeiGene: Consultancy, Other: Advisory Board, Research Funding, Speakers Bureau. Epperla: Pharmacyclics: Other: Ad Board; Seattle Genetics: Other: Ad Board; BeiGene: Other: Ad Board; TG Therapeutics: Other: Ad Board; Novartis: Honoraria; Incyte: Speakers Bureau. Shouse: Beigene Inc USA: Honoraria; Kite Pharma: Speakers Bureau. Romancik: AstraZeneca: Membership on an entity's Board of Directors or advisory committees. Moyo: Seattle Genetics: Consultancy. Hess: AstraZeneca: Consultancy, Speakers Bureau; Bristol-Myers Squibb: Consultancy; ADC Therapeutics: Consultancy. Ma: Bristol Myers Squibb: Consultancy; Janssen: Consultancy, Research Funding, Speakers Bureau; Pharmacyclics: Consultancy, Research Funding, Speakers Bureau; TG Therapeutics: Consultancy, Research Funding; Juno: Research Funding; Loxo: Research Funding; BeiGene: Consultancy, Research Funding, Speakers Bureau; AstraZeneca: Consultancy, Research Funding, Speakers Bureau; Abbvie: Consultancy, Research Funding. Moreira: CTI BioPharma: Consultancy; Ingenio Rx: Consultancy. Winter: Servier: Consultancy, Other: For Spouse; CVS/Caremark: Consultancy, Other: For Spouse; Astellas: Other: For Spouse, to University of Chicago, Research Funding; Forty Seven/Gilead: Other: For Spouse, to University of Chicago, Research Funding; Rafael: Other: For Spouse, to University of Chicago, Research Funding; Novartis: Consultancy, Other: for Spouse, to the University of Chicago, Research Funding; Daiichi Sankyo: Other: for Spouse, to the University of Chicago, Research Funding; Cellectis: Other: for Spouse, to the University of Chicago, Research Funding; Merck & Co., Inc.: Honoraria, Research Funding. Pro: verastem: Research Funding. Stephens: TG Therapeutics: Consultancy; Lilly: Consultancy; Genentech: Consultancy; Celgene: Consultancy; Beigene: Consultancy; Epizyme: Consultancy; CSL Behring: Consultancy; Newave: Research Funding; AstraZeneca: Consultancy; AbbVie: Consultancy; Novartis: Research Funding; Mingsight: Research Funding; Karyopharm: Research Funding; JUNO: Research Funding; Arqule: Research Funding; Acerta: Research Funding. Danilov: Nurix: Consultancy, Research Funding; Takeda Oncology: Research Funding; Astra Zeneca: Consultancy, Research Funding; Bayer Oncology: Research Funding; Bristol-Meyers-Squibb: Consultancy, Research Funding; Cyclacel: Research Funding; MEI: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding; Genentech: Consultancy; Morphosys: Consultancy; Incyte: Consultancy; Beigene: Consultancy; GSK: Consultancy; Pharmacyclics: Consultancy. Shah: Bristol Myers Squibb: Consultancy; Lilly Oncology: Consultancy, Honoraria; Novartis: Consultancy; Miltenyi Biotec: Consultancy, Research Funding; Incyte Corporation: Consultancy, Honoraria, Speakers Bureau; Epizyme: Consultancy; TG therapeutics: Consultancy; Kite Pharma: Consultancy. Cohen: BeiGene: Consultancy, Research Funding; Genentech: Research Funding; Lilly Oncology/Eli Lilly: Consultancy, Research Funding; Takeda: Research Funding; Kite Pharma/Gilead: Consultancy; BMS/Celgene: Research Funding; Novartis: Research Funding; Astrazeneca: Consultancy, Research Funding; Aptitude Health: Consultancy; Janssen: Consultancy; HutchMed: Consultancy, Research Funding. Barta: Kyowa Kirin: Consultancy, Honoraria; Seagen: Honoraria; Affimed: Consultancy; Daiichi Sankyo: Consultancy; Acrotech: Honoraria; Janssen: Other: Independent Data Monitoring Committee member. Torka: ADC Therapeutics: Consultancy; Epizyme: Consultancy; Targeted Oncology, Physician Education Review: Honoraria; TG Therapeutics: Consultancy; Lilly USA: Consultancy; Genentech: Consultancy. Gordon: Zylem: Current equity holder in private company, Current equity holder in publicly-traded company, Patents & Royalties: Patent on nanoparticles for lymphoma therapy; Janssen: Other: DSMB; Ono Pharmaceuticals: Consultancy; BMS: Research Funding.

*signifies non-member of ASH