Center for Advanced Practice

Title

Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy.

Authors

Haley Newman, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Yimei Li, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Hongyan Liu, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Regina M Myers, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Vicky Tam, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Amanda DiNofia, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Lisa Wray, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Susan R Rheingold, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Colleen Callahan, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Claire White, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Diane Baniewicz, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Lena E Winestone, Children's Hospital of Philadelphia, Philadelphia, PA
Stephan Kadauke, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Caroline Diorio, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Carl H June, Children's Hospital of Philadelphia, Philadelphia, PA
Kelly D Getz, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Richard Aplenc, Children's Hospital of Philadelphia, Philadelphia, PAFollow
David T Teachey, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Shannon L Maude, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Stephan A Grupp, Children's Hospital of Philadelphia, Philadelphia, PAFollow
Kira Bona, Children's Hospital of Philadelphia, Philadelphia, PA
Allison Barz Leahy, Children's Hospital of Philadelphia, Philadelphia, PA

Publication Title

Blood

Document Type

Article

PubMed ID

36351239

Abstract

Children living in poverty experience excess relapse and death from newly diagnosed acute lymphoblastic leukemia (ALL). The influence of household poverty and neighborhood social determinants on outcomes from CAR T-cell therapy for relapsed/refractory (r/r) leukemia is poorly described. We identified patients with r/r CD19+ ALL/lymphoblastic lymphoma treated on CD19-directed CAR T-cell clinical trials or with commercial tisagenlecleucel from 2012 to 2020. Socioeconomic status (SES) was proxied at the household-level, with poverty-exposure defined as Medicaid-only insurance. Low neighborhood opportunity was defined by the Childhood Opportunity Index. Among 206 patients aged 1-29, 35.9% were household-poverty exposed, and 24.9% had low neighborhood opportunity. Patients unexposed to household-poverty or low-opportunity neighborhoods were more likely to receive CAR T-cell therapy with high disease burden (>25%)-a disease characteristic associated with inferior outcomes-as compared to less advantaged patients (38% vs 30%; 37% vs 26%). Complete remission (CR) rate was 93% with no significant differences by household-poverty (P = 0.334) or neighborhood opportunity (P = 0.504). In multivariate analysis, patients from low-opportunity neighborhoods experienced increased hazard of relapse as compared to others (P = 0.006, adjusted HR 2.3, 95% CI 1.3-4.1). There was no difference in hazard of death (P = 0.545, adjusted HR 1.2, 95% CI 0.6-2.4). Among children who successfully receive CAR T-cell therapy, CR and OS is equitable regardless of proxied SES and neighborhood opportunity. Children from more advantaged households and neighborhoods receive CAR T-cell therapy with higher disease burden. Investigation of multicenter outcomes and access disparities outside of clinical-trial settings is warranted. Clinical trials: NCT01626495; NCT02435849 ; NCT02374333; NCT02228096; NCT02906371.

DOI

10.1182/blood.2022017866

Publication Date

11-9-2022

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