Children and young adults with relapsed or refractory (R/R) acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma who underwent chimeric antigen receptor T-cell (CAR-T) therapy had similar remission and survival outcomes regardless of socioeconomic status. These findings were published in the journal Blood.
Socioeconomic status can affect access to health care and treatment outcomes. Data to investigate the relationship between CAR-T therapy and outcomes among young patients were sourced from Children’s Hospital of Philadelphia (CHOP). Exposure to household poverty was defined as having public insurance and neighborhood opportunity was proxied using the 2015 Childhood Opportunity Index (COI).
A total of 206 patients, median age 12.5 (range, 1.4 to 29.1) years, with R/R ALL or lymphoblastic lymphoma were included in this analysis. Patients who were exposed to household poverty or neighborhood deprivation were more likely to be Black or Hispanic and to undergo CAR-T therapy with lower marrow disease burden.
The complete remission rates were 93.9% for patients unexposed to poverty and 91.9% for those exposed to poverty (P =.334).
No significant effects on overall survival were observed for any poverty or disadvantage measures (all P ≥.545).
For relapse-free survival, patients with low COI had a higher risk for relapse than the patients with high COI (adjusted hazard ratio [aHR], 2.3; P =.006).
The type of relapse differed on the basis of socioeconomic status, in which CD19+ relapse was more common with low COI scores compared with high COI scores (24.4% vs 12.6%).
This study may have been limited by not assessing family-reported poverty exposure.
The results of this study indicated that complete remission and overall survival is similar regardless of socioeconomic status. However, disease burden in this study was lower among patients exposed to poverty, which leads to better outcomes. “[T]his difference could indicate inequity in access or bias in referral patterns, with providers less willing to recommend sicker patients of lower socioeconomic status for travel to a tertiary care center for therapy,” the study authors noted in their report.
Newman H, Li Y, Liu H, et al. Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy. Blood. Published online November 9, 2022. doi:10.1182/blood.2022017866