CAR-T (920th Hospital of Joint Logistics Support Force of People's Liberation Army of China)

Chimeric antigen receptor (CAR) T-cell (CAR-T) therapy has shown curative potential for patients with diffuse large B-cell lymphoma (DLBCL) and other malignancies, but its accessibility among Medicare patients, particularly in disadvantaged populations, remains uncertain. This study aims to assess CAR-T use among Medicare patients with DLBCL receiving third-line or later (3L+) treatment, focusing on access disparities and their impact on clinical outcomes. Using Surveillance, Epidemiology, and End Results (SEER)–Medicare data from 2007 to 2020, multivariate logistic regression was used to evaluate patient characteristics and the effects of distance to authorized treatment centers (ATCs) on CAR-T access. Between 2017 and 2020, 2241 patients were treated for 3L+ DLBCL in the SEER-Medicare data, of whom 122 (5.4%) received CAR-Ts. CAR-T recipients were less likely to have multiple comorbidities (odds ratio [OR], 0.904; P = .001) but more likely to live in higher income areas (OR, 1.176; P = .004). If distance to the nearest ATC for “poor-access” states (average distance to ATC, 104.4 miles) decreased to the average distance in “better-access” states (34.2 miles), there would be a 37.6% increase in number of patients receiving CAR-Ts (6.6%-9.1%; P < .001). These findings highlight substantial disparities in CAR-T use, driven by geographic and socioeconomic factors. Addressing these barriers could significantly enhance equitable access to CAR-T therapy and improve outcomes for underserved populations, emphasizing the need for targeted interventions to reduce geographic and systemic barriers to care.