BCMA CAR T Access Disparities Persist Among Racial/Ethnic Minority Patients With Myeloma

A study conducted at the University of Pennsylvania and published in Blood Immunology and Cellular Therapy has uncovered disparities in access to chimeric antigen receptor T-cell (CAR T) therapy targeting B-cell maturation antigen (BCMA) for treatment of multiple myeloma (MM) between racial and ethnic minority populations (REMPs) and non-REMPs, despite having similar clinical outcomes.¹

BCMA-targeting CAR T-has emerged as a key treatment for MM, with idecabtagene vicleucel (ide-cel; Abecma) and ciltacabtagene autoleucel (cilta-cel; Carvykti) currently approved for clinical use. A notable finding was that REMP patients had limited access to CART compared with their non-REMP counterparts as evidenced by a significant reduction in proportion of racial minority patients with MM (28.1%) across CAR T eligibility (26.1%) and receipt (17.1%) (P <.05).

Despite disparities in access, clinical efficacy outcomes were still comparable between REMPs and non-REMPs in terms of very good partial response (75% vs 72%; P =.47), progression-free survival (HR, 0.74; 95% CI, 0.41–1.31; P =.30), and overall survival (HR, 0.87; 95% CI, 0.39–1.94; P =.73). Similar safety profiles were also observed, with no significant differences in cytokine release syndrome, neurotoxicity, and long-term hematologic toxicities.

“This study highlights that although the access of REMP patients with MM at our institution is substantially preserved, their access to CAR T therapy is reduced, suggesting that REMPs may have inequitable access to this therapeutic option. Nevertheless, when treated with [BCMA-targeted] CAR T, REMP patients have comparable efficacy and toxicity to the non-REMP population,” stated the investigators, Paruzzo et al, in the manuscript.¹

Prior literature has established that REMPs shoulder a disproportionate burden of myeloma cases,² raising concerns about how barriers to treatment may potentially impact clinical outcomes. Moreover, despite overrepresentation of REMPs in myeloma, their underrepresentation in the KARMMA clinical trials (NCT03361748) evaluating ide-cel and CARTITUDE trials (NCT04181827) investigating cilta-cel, along with a lack of real-world data on cilta-cel outcomes in REMPs, was what prompted this research, according to the investigators.¹

What Were the Cohort and Patient Characteristics?

The study analyzed 3 retrospective cohorts of patients with MM at the Abramson Cancer Center (ACC) at the University of Pennsylvania in Philadelphia, Pennsylvania, between June 2021 and February 2024: a cohort of patients with MM (n = 288, known races; n = 299, known ethnicity), a cohort of patients with MM who met the eligibility criteria for CAR T treatment (n = 115), and a cohort of patients with MM who received BCMA-targeted CAR T (n = 140, known races; n = 141, known ethnicity).

The study also characterized demographics of the general ACC catchment area, the Philadelphian metropolitan area, which consists of 12 counties across southeastern Pennsylvania, southern New Jersey, and northern Delaware. This cohort comprised 3298 patients with known race, diagnosed with MM between January 2016 and December 2020. An analysis of the catchment area showed that about one-third of patients (n = 1117/3298) newly diagnosed with MM were racial minorities, with 31.8% identifying as Black/African American and 2.1% identifying as Asian.

Racial minority status was determined with self-reported identification as American Indian or Alaska Native, Asian, Black/African American, or Native Hawaiian or other Pacific Islander; ethnic minority status was defined as identification as Hispanic/Latino or non-Hispanic. Race and ethnicity data were obtained from the electronic medical record.

What Are Driving These Disparities?

Further prospective studies are warranted to explore risk factor associations and ascertain potential causes, as the present study was not sufficiently powered nor designed to capture this question. Still, the study suggested that disparities in treatment access may stem from socioeconomic, spatial, insurance, and logistical limitations.

The study examined key social determinants of health (SDOH) within the patient population, including place of residence, transportation time, marital status, employment status, and type of health insurance. This analysis revealed that REMP patients who received CAR T were more likely to live closer to the ACC and less likely to be married compared with non-REMP patients (P <.05), highlighting potential risk factors for reduced CART access. Identification of such factors can help inform the development or modification of programs or policies that can address these SDOH barriers and ensure equitable access to commercial CART therapies for MM treatment.

“Although a detailed discussion of effective strategies to address inequitable access falls outside the scope of this article, we think that achieving equitable access to cellular immunotherapies requires a collaborative approach. Patient associations, scientific societies, health care providers, government, and pharmaceutical companies must align efforts to address socioeconomic and logistical barriers,” concluded the investigators.¹

REFERENCES:

1. Paruzzo L, Eshaghi K, Ghilardi G, et al. Access and outcomes of racial and ethnic minority populations receiving commercial anti-BCMA CART for myeloma. Blood Immunology & Cellular Therapy. 2025;1(2):100007. doi:https://doi.org/10.1016/j.bict.2025.100007

2. Kanapuru B, Fernandes LL, Fashoyin-Aje LA, et al. Analysis of racial and ethnic disparities in multiple myeloma US FDA drug approval trials. Blood Adv. 2022;6(6):1684-1691.