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Montefiore in the News

May 12, 2022

NEW YORK (Reuters Health) - Black and Hispanic cancer patients who underwent CAR-T therapy at a single center had comparable outcomes to their white and Asian counterparts, researchers say.

"We were not surprised at the outcome, but our findings helped us resolve the unknown, and we feel that much more confident about the treatments we're providing our community," Dr. Mendel Goldfinger of Montefiore Health System and Albert Einstein College of Medicine in New York City told Reuters Health by email. "There are differences in disease biology and immune responses for different ethnic groups, so we wanted a data-driven approach to ensuring that we are providing the best care possible."

"Our findings that minorities have equal outcomes and side effects from CAR-T cell therapy should give physicians confidence about use of these therapies, particularly for individuals underrepresented in clinical trials," he said. 

The real-world exploratory retrospective cohort study published in Blood Marrow Transplantation included data from 46 patients who received CAR-T cells at Montefiore Medical Center between 2015-2021, including 26 minority patients (17 Hispanic, 9 African-American) and 20 non-minority patients (16 Caucasian, 4 Other). 

Men and women were equally distributed in the minority group, whereas women predominated in the non-minority group. The median age at the time of CAR-T cell therapy was 60.5 for minorities and 72 for non-minorities. 

Twenty-four patients (92%) in the minority group had a diagnosis of diffuse large B-cell lymphoma (DLBCL), one (4%) had follicular lymphoma and one (4%) had mantle cell lymphoma (MCL). In the non-minority group, 17 (85%) had DLBCL and three (15%) had MCL. 

Twenty-five (96%) minority and 17 (85%) non-minority patients, received the axicabtagene ciloleucel CAR-T cell product. One minority patient (4%) and three non-minority patients (15%) received brexucabtagene autoleucel.

The median time from referral to cell infusion was comparable between the groups, at about 41 days. 

In the minority group, 15 (58%) patients achieved a complete response; five (19%) achieved a partial response; and six (23%) progressed. 

In the non-minority group, 14 (70%) had a complete response, four (20%), a partial response; and two (10%) progressed. Between-group differences were not significant. 

At the time of study submission, in the minority group 12 patients remained in remission, one had a partial response to therapy and 13 had died. In the non-minority group, nine patients remained in remission, two had disease progression, six had died, and two were lost to follow-up. 

Progression-free survival was similar between the groups: median not reached in the minorities group and 11.9 months in the non-minorities group 

Overall survival for the minorities group was 46.3 months and not reached for the non-minorities. 

The cumulative incidence of disease progression and death was similar in both groups, as were CAR-T toxicities. 

Dr. Sairah Ahmed, Director of the CAR-T Program and Inpatient Medical Director, Department of Lymphoma/Myeloma at the University of Texas MD Anderson Cancer Center in Houston, commented on the study in an email to Reuters Health.

 "This is a really important area...that needs study and a nuanced approach, as it's an intersection of race, ethnicity, insurance coverage, socioeconomic barriers, and resources offered in geographic proximity to...patients," she said.

"This study is a small single-center experience wherein they report on a mixed population that generally cannot be combined for the purposes of disease outcomes - large cell lymphoma, follicular lymphoma and mantle cell lymphoma," she noted.

"There are inherent biases when conducting retrospective studies," she said, particularly regarding why certain patients get treated and others do not.

"Looking at this question in large databases with multiple institutions will alleviate some of the biases in answering this question of outcomes by comparing disease characteristics and patient characteristics as well as other aspects of treatment," she added.

"This study highlights that minority populations should be included in trials and have access to CAR-T commercial products. However, at the present time, this is an area where there are substantial gaps," Dr. Ahmed concluded.

SOURCE: Blood Marrow Transplantation, online April 28, 2022.