CAR T treatment access and outcomes in patients with large B‐cell lymphoma according to ethnicity and socioeconomic deprivation

Background: CAR T-cell therapy has revolutionised treatment of relapsed/refractory (r/r) large B-cell lymphoma (LBCL), but it is unclear whether access and clinical benefit is equal for ethnic minorities and deprived communities. We analysed outcomes of LBCL patients approved for CD19 CAR T at 2 UK centres serving a large and diverse population, according to ethnicity and socioeconomic deprivation. Methods: Consecutive patients with r/r LBCL approved for 3L axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) between January 2019 and December 2022 at King’s College Hospital London and University Hospital Birmingham were included. Data on deprivation was obtained through the Index of Multiple Deprivation (IMD) 2020 according to patients’ postcode. The IMD ranks between 1 and 10 and includes different factors relating to healthcare inequalities (e.g., income, employment, education). Patients were grouped into high (IMD 1–3) and low deprivation (8–10). Results: 245 patients were included, 193 approved for axi-cel, 52 for tisa-cel. Deprivation data were available for 218 patients. The product choice did not differ according to ethnic or deprivation groups. Patients’ median age was 61y. Ethnic groups were as follows: 214/245 (87%) White, 22 (9%) Asian, 7 (3%) Afro-Caribbean, 2 mixed race. 21% of patients were from areas of high deprivation. 53% of patients travelled >50 km to the CAR T centre, 25% >100 km. 82% patients were infused, with no significant difference according to ethnicity, deprivation or distance to the centre. Ethnic minority patients came from more deprived areas versus white patients (med. IMD 7 vs. 5 vs. 4 in White, Asian and Afro-Caribbean patients, respectively; p = 0.04). Distance to the CAR T centre was longer in white versus ethnic minority patients (med. 59 vs. 18 km, p = 0.03). There were more patients with ECOG PS 0 from low deprivation areas (46% vs. 31%; p = 0.04), otherwise no significant differences of baseline characteristics, i.e., LDH, bulk, stage, IPI, bridging response, or vein-to-vein time according to ethnicity or deprivation. No difference was observed in high-grade ICANS, incidence of CRS, ICU requirement, tocilizumab/steroid use or non-relapse mortality with respect to ethnicity or deprivation. CAR T response and progression-free survival were similar across ethnic and deprivation groups. Among patients who progressed after CAR T, those from areas of low deprivation were more likely to receive further therapies (79% vs. 48%, p = 0.02). Patients from low deprivation areas had better overall survival (OS; 1-y OS 61% vs. 45%, p = 0.04). Keywords: Cancer Health Disparities, Cellular therapies, Immunotherapy No conflicts of interests pertinent to the abstract.