INTRODUCTION: Chimeric antigen receptor (CAR) T-cell therapies have emerged as a transformative treatment for relapsed/refractory multiple myeloma (RRMM) with the first FDA approval in 2021. Despite their substantial survival benefits, real-world access to CAR T remains limited across many regions of the United States (US). Geographic barriers such as long travel distances to authorized treatment centers (ATCs) and systemic inequities limit access to CAR Ts, particularly in underserved regions. Currently, there is no comprehensive estimate of the extent of these barriers or their impact on CAR T access in RRMM. This study visualizes geographic variation in multiple myeloma (MM) burden and identifies key drivers of the disparity in CAR T access to inform targeted strategies in closing access gaps.

METHODS: Using the Komodo Patient-Level Analytics and Insights Derivative (PLAID) administrative claims database, we estimated MM burden at various levels for January 2021-August 2024. MM patients and CAR T recipients were identified in the database using International Classification of Diseases (ICD)-10 and billing codes respectively. MM prevalence rates at the ZIP-3 level (using the first 3 digits of a ZIP) were estimated using input from the US Cancer Statistics (USCS) database. Distance to the nearest ATC for all MM patients and drive-time to ATCs for patients receiving CAR Ts were estimated. All estimates were compared by region and to the overall MM population nationally. Results at the ZIP-3 level will be visually represented on US geospatial maps.

RESULTS: There were 106,593 prevalent MM cases over the study period. Patients who received CAR T tend to be slightly younger but otherwise had similar distribution as the overall MM patient population in the study across categories of sex (male and female), US Census Bureau defined regions (Northeast, Midwest, South, and West), and insurance type (Commercial/Medicare Advantage, Medicare fee-for-service, and Medicaid). Disease burden varied geographically, with numerically higher burden observed in the South (65/100,000) and Northeast (66/100,000) regions, relative to the overall US rates (60/100,000). Hotspot analysis revealed local clusters of MM burden in Florida, Mississippi, and New York. Although the majority (71.1%) of patients with MM resided within 50 miles of an ATC, this proportion dropped to 65.8% in the South and 65.3% in the Midwest versus 87.3% in the Northeast. In all regions, a higher proportion of MM patients within 50 miles of an ATC received CAR Ts than those beyond this distance. Median drive-times to an ATC among CAR T recipients differed, with patients in the South having the longest journeys (1.7 hours, IQR 0.8-3.3), followed by Midwest (1.4 hours, IQR 0.6-2.7), relative to the national estimate (1.3 hours, IQR 0.7-2.8). More CAR T recipients in the Midwest and South regions also drove both >2 hours and out-of-state to an ATC (20.8% and 19.4%, respectively), compared with the Northeast which had the lowest proportion (10.3%)​. Additional analyses on sociodemographic factors, along with access barriers, are being examined and findings will be presented.

CONCLUSIONS: This study highlights the geographic disparities in MM disease burden and access to CAR Ts through ATCs for RRMM patients in the US. MM prevalence was highest in the South and Northeast, while access to ATCs in the form of distance and drive-times were the least favorable in the Midwest and South, relative to the overall US. These results identified areas with the highest need to reduce access gaps for patients, potentially leading to enhanced CAR T utilization. The study continues to identify potential sociodemographic factors behind the drive-time disparities, which will be presented in more detail. Overcoming these barriers is critical to expanding equitable access to CAR Ts in MM and improving outcomes overall and among underserved communities.

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2025
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