Investigating CAR-T Treatment Access for Multiple Myeloma Patients Using Real-World Evidence.

Objective: Multiple myeloma (MM) is the second most common hematologic malignancy in the U.S., with Black patients being diagnosed at twice the rate of White patients. MM treatment options are limited and ineffective, but CAR-T therapies show promise. However, their limited availability results in disparities in access. This study aimed to explore disparities in Multiple Myeloma disease risk and CAR-T therapy access. Methods: Our study included a population-based cohort of 12,360 patients diagnosed with Multiple Myeloma who received more than one cancer therapy extracted from the University of California Health Data Warehouse (UCHDW) between January 2021 and November 2024. Regression models were used to compute odds ratio (OR) and 95% confidence intervals (CI) associating disease severity, UC-Location, and baseline demographics with CAR-T therapy access. The GPT-4 inference model was prompted with a zero-shot learning approach to analyze UCSF clinical notes with the following objectives: (1) Was CAR-T discussed? [yes/no], (2) Is the patient eligible for CAR-T? [yes/no/unclear], and (3) Provide the rationale for the eligibility determination. Results: Our study included 12,360 patients (mean age 68.5 years, SD 12.8 years) treated for multiple myeloma across the University of California Health System, 320 of which received CAR-T (Table-1). Overall, 51.6% of MM patients identified as Male, and 48.4% as Female. Disease Severity was measured by the International Staging System (ISS) and was distributed by ISS Stage: I (65.3%), II (24.4%), III (2.8%), and None (7.5%). Patients treated at UC-1 (49.3%), and UC-2 (50.0%) were primarily diagnosed with Stage II, while patients at UC-3 (55.5%) were primarily diagnosed with Stage I. Our model indicated that patients who identified as Black or African American (OR= 0.33, [95% CI, 0.17-0.62) were less likely to receive CAR-T therapy when compared to White patients. Patients treated at UC-3 with predominantly Black or African American patients (OR = 0.42, [95% CI, 0.30-0.59]) were less likely to receive CAR-T therapy when compared to UC-1. We identified CAR-T eligibility for 270 UCSF patients and found those who identified as other Pacific Islander had the highest rate of eligibility without discussions at 50%, followed by Black or African American (4.2%), Asian (3.2%), and White (0.6%). Conclusion and Relevance: This study emphasizes the influence of race and UC-Location on disparities in CAR-T therapy access.