Marco Ruella, MD, an assistant professor of medicine (hematology-oncology) in the Department of Medicine in the Division of Hematology/Oncology and the Center for Cellular Immunotherapies at the University of Pennsylvania Perelman School of Medicine; as well as the scientific director of the Lymphoma Program at the Hospital of the University of Pennsylvania

Dr Ruella on the Importance of Clinical Trial and Treatment Accessibility for Myeloma

"Therapy that cannot be done in a tertiary center is not going to be equitable and accessible to everyone, and so we need to develop these therapies in a way that can potentially be implemented in the community."

Marco Ruella, MD, an assistant professor of medicine (hematology-oncology) in the Department of Medicine in the Division of Hematology/Oncology and the Center for Cellular Immunotherapies at the University of Pennsylvania Perelman School of Medicine; as well as the scientific director of the Lymphoma Program at the Hospital of the University of Pennsylvania, discusses the importance of developing cancer treatments, including CAR T-cell therapy, that are accessible to diverse populations of patients with multiple myeloma.

 often feature research investigating highly sophisticated and advanced therapies, Ruella begins. However, if these treatments cannot be delivered equitably to patients, the extent of their real-world benefit remains unknown, he says. Therefore, considering accessibility is crucial when designing clinical trials and determining the commercial application of these therapies, he explains. 

Treatments that can only be administered in tertiary centers will not be universally accessible to patients, limiting their reach, Ruella notes. Accordingly, it is essential for drug developers to consider the feasibility of incorporatingthese agents into community practices in the future, he emphasizes. These considerations should be accounted for early in the drug development process to promote equitable health care access, he notes. 

At the 2024 ASH Annual Meeting, Ruella and colleagues presented findings from an analysis of treatment access and outcomes in minority health populations receiving commercial BCMA-directed CAR T-cell therapy for multiple myeloma. This research showed that patients in minority health populations have equitable access to tertiary care for multiple myeloma when compared with those in non-minority health populations but have reduced access to commercial anti-BCMA CAR T-cell therapy. 

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Marco Ruella, MD, discusses ways to develop accessible cancer treatments to more greatly benefit diverse populations of patients with multiple myeloma.

Dr Ruella on Improving Access to CAR T-Cell Therapy for Minority Populations in Multiple Myeloma

"We need to act both on the patient side and the healthcare provider side, in the sense that we need to educate providers to be aware of potential unconscious biases. At the same time, we also need to [ask ourselves:] does the patient have the knowledge about the treatment? Are we addressing the potential concerns that might be well-founded? Are we helping to making this therapy feasible [for them]?"

Marco Ruella, MD, assistant professor, medicine (hematology-oncology), Perelman School of Medicine; scientific director, Lymphoma Program, the Hospital of the University of Pennsylvania, discusses the implications of findings from a retrospective study evaluating access to and outcomes with commercial BCMA-targeted CAR T-cell therapy for the management of multiple myeloma in minority health populations.

A retrospective study compared access to BCMA-targeted CAR T-cell therapy among minority health populations and their outcomes with that of nonminority populations, Ruella details. The study evaluated 3 cohorts of patients with multiple myeloma from the Abramson Cancer Center: the catchment area cohort (3217 patients), the Abramson multiple myeloma cohort (1747 patients), and the BCMA-targeted CAR T-cell cohort, which comprised 122 patients treated with commercial CAR T-cell therapy.

Results revealed a progressive reduction in the percentage of minority health population patients as the cohort narrowed from the general catchment area to those receiving BCMA-targeted CAR T-cell therapy. This suggests that although minority health populations generally have access to tertiary care for multiple myeloma, their access to commercial CAR T-cell therapy is significantly diminished, particularly for those residing outside the catchment area. However, when patients in minority health populations received BCMA-targeted CAR T-cell therapy, their survival and safety outcomes were similar to those of nonminority patients.

The findings underscore the importance of systematically recording data related to the socioeconomic status, race, and ethnicity of patients, Ruella states, adding that accurate and comprehensive databases will help provide a clearer snapshot of health disparities in the treatment of multiple myeloma. Addressing these disparities requires action on both the health care provider and patient sides, he emphasizes. Health care providers must be educated to recognize and mitigate unconscious biases that may affect treatment decisions, ensuring that therapies are offered based on measurable data rather than assumptions tied to a patient’s background, he says.

On the patient side, it is crucial to ensure that individuals are well-informed about treatment options and that their concerns are addressed, Ruella continues. Efforts should also be made to make therapies more feasible, such as providing assistance with transportation or covering out-of-pocket expenses, he adds. Collaborative initiatives are essential in implementing prospective solutions to address these challenges, ultimately promoting more equitable access to cutting-edge therapies like BCMA-targeted CAR T-cell therapy, Ruella concludes.

Marco Ruella, MD, discusses strategies to improve access to CAR T-cell therapy for the management of multiple myeloma in minority health populations.

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“We saw a progressive reduction of the percentage of [minority] patients…when you go from the catchment area to the cancer center, but in particular to the CAR T-cell [cohort]. So, the study suggests that there might be a gap in access to BCMA-[directed] CAR T-cell [therapy] for the minority health population.”

Marco Ruella, MD, assistant professor of medicine, Division of Hematology/Oncology, Center for Cellular Immunotherapies; scientific director, Lymphoma Program, Hospital of the University of Pennsylvania, discusses findings highlighting disparities in access to commercial BCMA-directed CAR T-cell therapy among minority health populations with multiple myeloma.

Multiple myeloma disproportionately affects African American patients, with a higher incidence compared with other racial groups, Ruella begins. Despite this, data suggest that minority patients face significant barriers to accessing advanced treatments, such as CAR T-cell therapy.

 evaluated the representation of minority patients in multiple myeloma populations across three levels: patients diagnosed with multiple myeloma in the Abramson Cancer Center catchment area, patients receiving care at Abramson Cancer Center, and patients treated with commercial BCMA-directed CAR T-cell therapy at the Abramson Cancer Center.

Patient outcomes in the third cohort, which included 100 non-minority health population patients and 22 minority health population patients, were the focus of the analysis. Baseline characteristics were similar, although the median age of the minority health population was younger compared with the non-minority health population, at 61 years vs 65 years. Similarly, these patients had received fewer median prior lines of therapy, at 6 vs 7, respectively.

Both groups had comparable efficacy outcomes, with 68.1% of minority health population patients and 70.7% of non-minority health population patients achieving at least a very good partial response. Median progression-free survival was 14.7 months for minority health population patients vs 16.5 months for non-minority health population patients.

Overall survival (OS) did not differ between groups, with medians that were not reached in either population. No significant differences in safety were observed, with comparable rates of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS), respectively, in the minority (91%; 9.1%) and non-minority (78%; 21%) health populations. 

Social determinants of access were also examined. Minority health population patients lived closer to the CAR T-cell therapy center vs non-minority health population patients, with a median travel time of 35 minutes vs 63 minutes, respectively. The respective median travel times were 27 minutes and 40 minutes for only those patients within the catchment area. Additionally, minority health population patients were less likely to be married vs non-minority health population patients, at a rate of 45.5% vs 79.0%, respectively. Employment status and insurance type did not differ by minority status.

Understanding the causes of these disparities is the next critical step, Ruella notes. Access to CAR T-cell therapy is influenced by multiple factors, including socioeconomic determinants, health care provider biases, patient hesitancy, and logistical challenges such as geographic distance from treatment centers. Future efforts will focus on identifying and addressing barriers to access, with the goal of implementing effective strategies to ensure all eligible patients can benefit from advanced immunotherapies, Ruella concludes.

Marco Ruella, MD, discusses disparities in access to commercial anti-BCMA CAR T-cell therapy among minority populations (MHPs) with multiple myeloma.

Marco Ruella, MD

Articles

Dr Ruella on the Importance of Clinical Trial and Treatment Accessibility for Myeloma

Dr Ruella on Improving Access to CAR T-Cell Therapy for Minority Populations in Multiple Myeloma

Dr Ruella on Access Disparities to CAR T-Cell Therapy in Minority Patients With Myeloma