Access Barriers to Anti-CD19+ CART-Cell Therapy for NHL Across a Community Transplant and Cellular Therapy Network.

Autor:	Battiwalla M; Sarah Cannon Transplant and Cellular Therapy Network, HCA Healthcare, Nashville, Tennessee, United States., Tees MT; Sarah Cannon Transplant and Cellular Therapy Network; 3. Presbyterian/St. Luke's Medical Center and Colorado Blood Cancer Institute, United States., Flinn IW; Tennessee Oncology and OneOncology, Nashville, Tennessee, United States., Pantin J; Sarah Cannon Transplant and Cellular Therapy Network, Nashville, Tennessee, United States., Berdeja JG; Tennessee Oncology, nashville, Tennessee, United States., Gregory T; Sarah Cannon Transplant and Cellular Therapy Network; Presbyterian/St. Luke's Medical Center and Colorado Blood Cancer Institute, United States., Maris MB; Sarah Cannon Transplant and Cellular Therapy Network; Presbyterian/St. Luke's Medical Center and Colorado Blood Cancer Institute, United States., Bhushan V; Sarah Cannon Blood Cancer Network, DALLAS, Texas, United States., Vance E M.D; Sarah Cannon Transplant and Cellular Therapy Network, Dallas, Texas, United States., Mathews J; Sarah Cannon Transplant and Cellular Therapy Network; Medical City Dallas Hospital and Texas Oncology, United States., Bachier C; Sarah Cannon Transplant and Cellular Therapy Network; Methodist Hospital, United States., Shaughnessy PJ; Sarah Cannon Transplant and Cellular Therapy Network; Methodist Hospital, United States., Ramakrishnan A; Sarah Cannon Transplant and Cellular Therapy Network; St. David's South Austin Medical Center, United States., Malik SA; Sarah Cannon Transplant and Cellular Therapy Network;6. St. David's South Austin Medical Center, United States., Mori S; AdventHealth Orlando, Orlando, Florida, United States., Martin C; Genospace, Inc., Kingston Springs, Tennessee, United States., Billups R; Sarah Cannon Transplant and Cellular Therapy Network, Nashville, Tennessee, United States., Blunk B; Sarah Cannon Transplant and Cellular Therapy Network, United States., LeMaistre CF; Sarah Cannon Transplant and Cellular Therapy Network, United States., Majhail NS; Tristar Centennial Medical Center, United States.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2024 Oct 17. Date of Electronic Publication: 2024 Oct 17.
DOI:	10.1182/bloodadvances.2024014171
Abstrakt:	We analyzed access barriers to anti-CD19+ chimeric antigen receptor T-cells (CART) for non-Hodgkin lymphoma (NHL) within a community-based transplant and cell therapy network registry. 357 intended recipients of FDA-approved anti-CD19+ CART were identified in the study period (2018 to 2022). Results showed that the median age at referral was 61 years, referral year was 2018 (4%), 2019 (14%), 2020 (18%), 2021 (26%), and 2022 (38%). Diagnoses were diffuse large B-cell (69%), follicular (13%), follicular/large (7%), mantle cell (4%), or other (7%). CART products infused were Axi-cel (62%), Tisa-cel (16%), Brexu-cel (13%) and Liso-cel (9%). 182 patients were infused with CART. The median durations between referral to consultation, consultation to apheresis, and collection to infusion were 11, 107, and 32 days, respectively. The median duration from consultation to CART infusion declined steadily from 207 days in 2019 to 108 days in 2022. [P <0.0001] 124 patients (41%) did not receive CART mostly for disease progression (34%) or poor health (15%). Multivariable logistic regression showed no significant differences in demographic, financial, or social determinants compared to those receiving CART. Notably, the proportion of ineligible patients declined from 53% in 2018-2020 to 34% by 2021-2022 [P=0.001]. In conclusion, 41% of community patients were unable to access timely CART therapy for NHL, mostly related to attrition from disease-related causes while overall time to infusion exceeded four months. Time to infusion as well as the proportion receiving CART improved over time. Reducing time to apheresis, early referral, and careful attention to salvage/bridging strategies are necessary. (Copyright © 2024 American Society of Hematology.)
Databáze:	MEDLINE
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