Access to Chimeric Antigen Receptor T Cell Clinical Trials in Underrepresented Populations: A Multicenter Cohort Study of Pediatric and Young Adult Acute Lymphobastic Leukemia Patients.

Autor: Hall AG; Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington. Electronic address: Anurekha.Hall@seattlechildrens.org., Winestone LE; Division of Pediatric Allergy, Immunology, and Blood & Marrow Transplantation, UCSF Benioff Children's Hospitals, San Francisco, California., Sullivan EM; Core for Biostatistics, Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington., Wu Q; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington., Lamble AJ; Division of Hematology and Oncology, University of Washington, Seattle Children's Hospital, Seattle, Washington., Walters MC; Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California., Aguayo-Hiraldo P; Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California; USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California., Baez Conde L; USC Norris Comprehensive Cancer Center, University of Southern California, Keck School of Medicine, Los Angeles, California., Coker TR; Department of Pediatrics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington., Dornsife D; Lazarex Foundation, Danville, California., Keating AK; Pediatric Blood and Marrow Transplantation, University of Colorado School of Medicine, Aurora, Colorado., Merino DM; Friends of Cancer Research, Washington, DC., Ramsey B; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington., Park JR; Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee., Agrawal AK; Division of Oncology, UCSF Benioff Children's Hospitals, Oakland, California.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2023 Jun; Vol. 29 (6), pp. 356.e1-356.e7. Date of Electronic Publication: 2023 Mar 24.
DOI: 10.1016/j.jtct.2023.03.022
Abstrakt: Chimeric antigen receptor T cell (CAR-T) therapy is a promising approach to improve survival for children and adults with relapsed/refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL), but these clinical trials might not be equally accessible to patients of low socioeconomic status (SES) or to patients from racial or ethnic minority groups. We sought to describe the sociodemographic characteristics of pediatric and adolescent and young adult (AYA) patients enrolled in CAR-T clinical trials and to compare these characteristics to those of other patients with r/r B-ALL. We conducted a multicenter retrospective cohort study at 5 pediatric consortium sites to compare the sociodemographic characteristics of patients treated and enrolled in CAR-T trials at their home institution, other patients with r/r B-ALL treated at these sites, and patients referred from an external hospital for CAR-T trials. The patients were age 0 to 27 years with r/r B-ALL treated at 1 of the consortium sites between 2012 and 2018. Clinical and demographic data were collected from the electronic health record. We calculated distance from home to treating institution and assigned SES scores based on census tract. Among the 337 patients treated for r/r B-ALL, 112 were referred from an external hospital to a consortium site and enrolled in a CAR-T trial and 225 were treated primarily at a consortium site, with 34% enrolled in a CAR-T trial. Patients treated primarily at a consortium site had similar characteristics regardless of trial enrollment. Lower proportions of Hispanic patients (37% versus 56%; P = .03), patients whose preferred language was Spanish (8% versus 22%; P = .006), and publicly insured patients (38% versus 65%; P = .001) were referred from an external hospital than were treated primarily at a consortium site and enrolled in a CAR-T trial. Patients who are Hispanic, Spanish-speaking, or publicly insured are underrepresented in referrals from external hospitals to CAR-T centers. External provider implicit bias also may influence referral of these patients. Establishing partnerships between CAR-T centers and external hospital sites may improve provider familiarity, patient referral, and patient access to CAR-T clinical trials.
(Copyright © 2023 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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