Impact of race and social determinants of health on outcomes in patients with aggressive B-cell NHL treated with CAR-T therapy.

ABSTRACT: Chimeric antigen receptor (CAR) T-cell (CAR-T) immunotherapy is an effective therapy for relapsed/refractory B-cell non-Hodgkin lymphoma (r/r B-NHL). However, data are limited on the impact of the convergence of race and social determinants of health on outcomes for patients treated with CAR-T therapy. We examined the impact of interactions between race and insurance type on health care use and outcomes in patients treated with CAR-T therapy for aggressive B-NHL. Adult patients with r/r B-NHL treated with CD19 CAR-Ts were identified between 2015 and 2021 across 13 US academic centers. Insurance type, demographic, and clinical data were collected and analyzed. In total, 466 adult patients were included in our analysis. Median follow-up after CAR-T therapy was 12.7 months. Median progression-free survival (mPFS) was longer for Caucasians (11.5 months) than for African Americans (3.5 months; hazard ratio [HR], 1.56 [1.03-2.4]; P = .04) or Asians (2.7 months; HR, 1.7 [1.02-2.67]; P = .04). Differences in median overall survival (mOS) were not significant. For Medicare (n = 206) vs Medicaid (n = 33) vs private insurance (n = 219) vs self-pay (n = 7): mPFS was 15.9 vs 4.2 vs 6.0 vs 0.9 months (P < .001), respectively; and mOS was 31.2 vs 12.8 vs 21.5 vs 3.2 months (P < .001), respectively. Our multicenter retrospective analysis showed that race and insurance status can affect outcomes for patients treated with CAR-T therapy.

Evaluating Socioeconomic, Racial, and Ethnic Disparities in Survival Among Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplants.

This study was undertaken to monitor potential disparities in survival after allogeneic hematopoietic stem cell transplantation (HSCT) with the aim of optimizing access and outcomes for minority and low-income patients. We analyzed 463 patients transplanted over a 72-month study period with a median 19-month follow-up, focused on differences by individual patient race/ethnicity and patients' household income derived from geocoded addresses at the census block group level. Patient sociodemographic and clinical characteristics were abstracted from electronic health records and our HSCT registry, including disease category and status, donor age, transplant type, and conditioning. Approximately, 15% of HSCT patients were non-Hispanic Black or Hispanic with a similar proportion from block groups below the median metropolitan Index of Concentration at the Extremes income score. The overall survival probability was 61.8% at 36 months. Non-Hispanic white (63.6%) and especially Hispanic patients (49.2%) had lower survival probabilities at 36 months than non-Hispanic Black patients (75.6%, p = 0.04). There were no other patient characteristics significantly associated with survival at the p < 0.01 level. The lack of significant differences likely reflects the careful selection of patients for transplants. However, the proportion of minority and low-income patients relative to expected disease prevalence in our area population raises important considerations about which patients successfully make it to transplant. We conclude with recommendations to increase the diversity of patients who receive HSCT by reviewing potential barriers in the transplant referral and selection process and advocating for needed psychosocial and community resources.

Improving Health Care Career Pipeline Programs for Underrepresented Students: Program Design that Makes a Difference.

BACKGROUND: Health care career pipeline training programs are one solution to increasing the number of minority and underrepresented health care providers. The Chicago Cancer Health Equity Collaborative (ChicagoCHEC) Research Fellows Program, a tri-institutional effort between the University of Illinois at Chicago (UIC), Northeastern Illinois University (NEIU), and Northwestern University (NU), provides a holistic, 8-week summer research fellowship that facilitates self-reflection, professional development, and exposes and guides the novice undergraduate and postbaccalaureate student toward a health care career inclusive of research and scientific discovery. OBJECTIVES: The number of underrepresented students achieving health care careers is minimal. We outline curriculum development, innovation, lessons learned, and selected outcomes from the first three cohorts of the ChicagoCHEC Research Fellows program. METHODS: A tri-institutional, collaborative curricular team was formed consisting of research faculty and staff at NEIU, UIC and NU. Once accepted, fellows experience a cohort model curriculum with particular emphasis to mindful inclusion of nontraditional students. The ChicagoCHEC Research Fellows Program uses evidence-based mentorship models, group reflection, and extensive program evaluation to continuously improve its program model. CONCLUSIONS: The 48 fellow alumni from the first 3 years reported high satisfaction with the program and will continued to be tracked for academic success. The ChicagoCHEC Research Fellows program will continue to provide academic and professional tools, sponsorship, and mentorship opportunities to underrepresented students as they progress toward health care careers. A program such as the ChicagoCHEC Fellows Program can serve as a useful model for increasing the number of minority researchers in health care careers.