The study finds no differences in CAR T-cell therapy outcomes in pediatric ALL patients across different socioeconomic levels

The study finds no differences in CAR T-cell therapy outcomes in pediatric ALL patients across different socioeconomic levels

Social determinants of health influence the outcome of many diseases, and childhood cancer is no exception. In fact, children with acute lymphoblastic leukemia (ALL) who live in poverty have a significantly higher risk of relapse and death from their disease than children from wealthier backgrounds. While socioeconomic status often influences survival outcomes, children with relapsed/refractory ALL treated with CAR T-cell therapy and living in poverty are just as likely to achieve overall survival as children from more socioeconomically advantaged households, according to a study published today in Blood.

CAR T-cell therapy is a type of immunotherapy in which a patient's T cells, immune cells in the body that fight infections, are removed, genetically modified in a laboratory to help them identify and fight cancer cells, and then infused back into the patient's bloodstream, where they find and destroy cancer cells. This therapy has proven successful in improving outcomes for people with ALL, but can be expensive, time-consuming, and largely out of reach for many marginalized populations.

Additionally, some researchers argue that marginalized groups may do less well with CAR T-cell therapy due to lower overall survival rates. However, the results of this new blood study may change that narrative.

What we see here is that in this cohort, CAR T-cell therapy is equally effective regardless of poverty risk. This study suggests that CAR T-cell therapies have equivalent effects.”

Haley Newman, MD, Pediatric Oncology Fellow in the Division of Oncology and Cancer Immunotherapy Program, Children's Hospital of Philadelphia (CHOP)

Dr. Newman and colleagues examined the outcomes of 206 CHOP-treated children and young adults with a median age of 12.5 years with reduced/refractory ALL who were enrolled in one of five CD19-targeted CAR-T cell clinical trials or with a commercial CAR-T, tisagenlecleucel. They collected data from clinical CAR T cell datasets and electronic medical records of patients treated between April 2012 and December 2020. The researchers then sorted the patients by socioeconomic and neighborhood opportunities, which they determined based on insurance types and patient addresses.

Children with statutory health insurance were considered to be affected by household poverty, while children with private or commercial insurance were not. Researchers used a census tract-based multidimensional quality measure of U.S. neighborhood metrics to determine neighborhood opportunities, or a household's access to resources that influence children's health and development, based on where patients live.

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"Many previous neighborhood studies have sorted data at the zip code level. We actually had address data for these patients that allowed us to geocode their census tract, which is where the Childhood Opportunity Index is measured," explained Dr. Newman.

The results showed no significant difference in overall survival or complete remission rates between patients exposed to household poverty and with fewer neighborhood opportunities and those from better-off households (who were not affected by household poverty or lived in neighborhoods with good opportunities).

Interestingly, the data also showed that children from wealthier households were significantly more likely to have a high disease burden at the time of referral for CAR T-cell infusion. Because high disease burden is associated with poorer outcomes and greater risks of toxicity, patients with severe disease are generally considered to be at higher risk for CAR T cell treatment.

Dr. Leahy, an oncologist in the Department of Oncology at CHOP, explains that while we know that patients with a higher disease burden are generally sicker, the data suggests that patients from wealthier households with a high disease burden are still being referred for CAR-T cell therapy, while those from lower socioeconomic groups may not be referred or have more difficulty getting the same treatment to use.

"We can't say exactly why we see a difference in disease burden, but it could be due to provider referral biases, families from more privileged households with more resources to access CAR-T and more flexibility to take time off from work, or there may be a difference in how families can advocate for their children to receive this therapy," explained Dr. Leahy.

While these results offer both hope and evidence for increasing access to CAR-T for individuals from disadvantaged households, researchers continue to emphasize the importance of replicating these results in larger populations outside of clinical trial settings. Dr. Newman noted that this study contains data from a single center, so its results cannot be generalized to populations outside of the CHOP community.

“This study shows us that patients from disadvantaged households do well with CAR T-cell therapy,” said Dr. Newman. “To me, that means we need to make this therapy more accessible, whether through new interventions or by providing families with more resources, like transportation and funding for sick leave.”

Source:

American Society of Hematology

Reference:

Newman, H., et al. (2022) Impact of neighborhood poverty and opportunity on outcomes for children treated with CD19-targeted CAR T-cell therapy. Blood. doi.org/10.1182/blood.2022017866.

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