Access offsets poverty in quest for CAR T cells

In this issue of Blood, Newman et al1 examined the influence of household poverty and neighborhood on access and outcomes of young patients treated with commercial (tisagenlecleucel) or investigational CD19 chimeric antigen receptor (CAR) T cells for relapsed/refractory B-acute lymphoblastic leukemia (B-ALL)/lymphoma. As a proxy for poverty, investigators used Medicaid-only insurance and the Childhood Opportunity Index, a multidimensional quality measure of US neighborhood metrics with scores across 3 domains of opportunity (education, health/environment, and social/economic).1 On the basis of nearly a decade of data from 206 patients (aged 1-29 years) treated at Children's Hospital of Philadelphia, the authors found that patients unexposed to household poverty were more likely to receive CAR T-cell therapy despite higher disease burden. As high disease burden is an independent prognosticator of worse outcome, it is notable that overall survival outcomes appeared the same between groups. Furthermore, despite similar rates of complete remission (CR), patients from low-opportunity neighborhoods experienced increased hazard of relapse but were less likely to proceed to salvage therapies.