Key points
Racial and Ethnic Minority Populations (REMPs) have reduced access to CART-BCMA therapies for multiple myeloma.
Clinical outcomes of both approved CART-BCMA products are comparable between REMPs and non-REMPs, despite disparities in access.
Abstract
Chimeric antigen receptor T-cell therapy targeting BCMA (CART-BCMA) is a transformative treatment for multiple myeloma (MM). However, its high cost and the need for specialized centers may limit access for Racial and Ethnic Minority Populations (REMPs), who are more impacted by MM. This retrospective cohort study evaluated access and outcomes according to REMP status for 140 MM CART-BCMA-treated patients (June 2021–February 2024) at the Abramson Cancer Center (ACC) of the University of Pennsylvania. These patients were compared to three control cohorts: 3,298 MM patients from the ACC catchment area, 288 MM patients treated at the ACC (ACC MM cohort) and 115 MM patients who would have been eligible for CART (ACC MM CART eligible cohort). The proportion of REMPs declined across cohorts (catchment area: 33.9%; ACC MM cohort: 28.1%; ACC MM CART eligible cohort: 26.1%, CART cohort: 17.1%; p<0.05). REMP patients receiving CART-BCMA were more likely to live closer to the ACC and were less likely to be married compared to non-REMPs (p<0.05). Nevertheless, clinical outcomes were similar, with comparable rates of very good partial response (REMP: 75% vs. non-REMP: 72%; p=0.47), progression-free survival (Hazard Ratio (HR):0.7, p=0.30), overall survival (HR: 0.9, p=0.73) both in the whole cohort and in the subgroup analyses based on the product used. Similarly, safety profiles showed no significant differences in cytokine release syndrome, neurotoxicity, and long-term hematological toxicities. In conclusion, REMPs have reduced access to CART-BCMA but show similar clinical outcomes with both approved CART-BCMA products, highlighting the need to improve equity in access.
