Neighborhood Socioeconomic Disadvantage and Distance from Treatment Center Do Not Impact Survival Outcomes of Patients with Non-Hodgkin's Lymphoma (NHL) and Multiple Myeloma (MM) Treated with CAR T-Cell Therapies.

Introduction Our study aimed to identify the impact of neighborhood disadvantage level on survival outcomes of recipients of CAR T-cell therapy as this has not yet been described. Methods Adult pts. with r/r B-NHL and MM who received CAR T-cell therapies at our center from 05/2018-01/2023 were included. Neighborhood disadvantage was defined by Area Deprivation Index (ADI), a validated tool that ranks census block groups (CBGs) based on income, education, employment, and housing quality at a national level. 2021 ADI percentile ranks (1-100) were obtained for each pt. using 9-digit zip code of their place of residence (higher rank corresponding to higher level of disadvantage). We compared OS and PFS (from date of CAR T infusion) between pts. with high and low ADI, and in relation to estimated distance from residence to treatment center (DTC). Results 124 and 45 pts. received CAR T therapy for B-NHL and MM, respectively. Median ages were 65 and 62 yrs., 68% and 51% were male, 94% and 84% were White, 30% and 69% had prior HSCT, and median number of prior therapies were 3 and 6, among pts. with B-NHL and MM, respectively. B-NHL subtypes included DLBCL (84%), MCL (6%), FL (5%), and PMBCL (5%), and CAR T products for B-NHL were axi-cel (52%), tisa-cel (24%), liso-cel (18%) and brexu-cel (6%). Ide-cel (82%) and cilta-cel (18%) were used in pts. with MM.We treated pts. from 169 CBGs over 8 states, although 89% pts. were from Ohio. Median ADI rank was 62.5 (range 1-100) and median DTC was 42.5 (range 1-4559) miles. Pts. were categorized as having high (> 62.5) or low (≤ 62.5) ADI, and long (> 42.5m) or short (≤ 42.5m) DTC. Longer DTC was significantly associated with higher ADI (p<0.001).Baseline characteristics (age, gender, prior therapies, prior HSCT, CAR T product) were similar across groups with low vs. high ADI and short vs. long DTC. Median duration of follow up was 12 (range 0-60) and 9 (range 0-22) months for pts. with B-NHL and MM, respectively. For pts. with B-NHL, objective response rates (ORR) (85% vs. 80%; p=0.4), relapse rates (RR) (66% vs. 66%; p=0.9), median OS (19 vs. 14 months; HR: 1.2; 95% CI 0.7-1.8; p=0.5) (Fig.1), and median PFS (10 vs. 5 months, HR: 1.1, 95% CI 0.7-1.7; p=0.6) were similar for pts. with low vs. high ADI. For pts. with MM, there were no differences in ORR (77% vs. 87%; p=0.3), RR (77% vs. 70%; p=0.5), median OS (14 vs. 18 months; HR: 0.8; 95% CI: 0.3-2; p=0.6) (Fig.2), and median PFS (7 vs. 9 months, HR: 0.7, 95% CI 0.3-1.4; p=0.3) between those with low vs. high ADI. There were no differences in median OS of pts. with short vs. long DTC for NHL (19 vs. 14 months; HR: 1.2, 95% CI 0.7-1.9, p=0.4) or MM (14 vs. 20 months; HR: 0.9, 95% CI 0.3-2.5; p=0.9). Conclusion Response rates and survival outcomes of patients with B-NHL or MM who received CAR T-cell therapies were equivalent regardless of neighborhood disadvantage level or DTC. Pts. living in more disadvantaged neighborhoods travelled longer distances for treatment.