PO.PS01.04 · 人群科学
Impact of neighborhood disadvantage, travel distance, and travel time on clinical outcomes of multiple myeloma patients treated with idecabtagene vicleucel
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摘要 Abstract
Purpose : To examine the association of neighborhood disadvantage and travel distance (TD)/time (TT) with clinical outcomes in multiple myeloma (MM) patients treated with the first chimeric antigen receptor T-cell therapy (CAR T) for MM, idecabtagene vicleucel (ide-cel).
Methods: MM patients who received ide-cel at Moffitt Cancer Center by July 2024 were included. Neighborhood disadvantage was defined using the Area Deprivation Index (ADI), Social Deprivation Index (SDI), and Social Vulnerability Index (SVI), with higher values indicating more disadvantaged neighborhoods (DN). TD/TT from patients' residence to Moffitt were calculated via Google Directions API. Chi-squared, log-rank tests, and Kaplan-Meier curves were used to compare patient characteristics, safety, and efficacy by each index and TD/TT using the upper quartile as the cut-point. Multivariable logistic and Cox regression were used to examine the association of each index and TD/TT with ide-cel response and survival, respectively, adjusting for relevant covariates.
Results: Among 173 MM patients treated with ide-cel, most were male (54%), non-Hispanic White (73%), and >60 years (75%). Median follow-up was 12.6 months (range 0.1-38.4). Median ADI was 42 (range 1-96), SDI was 38 (range 1-100), and SVI was 0.7 (range 0.1-1.0). Patients living in more vs less DN were younger (all indices, p<0.05), more likely to be Black (SDI: 37% vs 10%, p<0.001), had a prior autologous stem cell transplant (ADI: 80% vs 61%, p=0.02), and extramedullary disease (ADI: 32% vs 14%, p=0.01). Patients with higher SVI were more likely to develop infections (44% vs 25%, p=0.02) and less likely to achieve a complete response (CR) or better (44% vs 63%, p=0.03). Patients living in more vs less DN had inferior overall survival (OS; SDI: median 27 months vs not reached, p=0.04; SVI: median 18 months vs not reached, p=0.01). In multivariable models, patients living in more vs less DN were less likely to have a CR or better response (SDI: odds ratio [OR]=0.39, 95% confidence interval [CI]=0.16-0.91; SVI: OR=0.40, 95% CI=0.17-0.90) and had worse OS (SDI: hazard ratio [HR]=1.78, 95% CI=0.97-3.28; SVI: HR=2.14, 95% CI=1.16-3.95). No other differences in outcomes were observed by DN. Median TD and TT were 76.5 miles (range 2.5-1079.6) and 90 minutes (range 10-1022), respectively. No differences in patient characteristics or clinical outcomes by TD/TT were noted except patients with a longer TD/TT were more likely to have high-risk cytogenetics (58% vs 28%, p<0.001). Patients from more DN had shorter TD/TT (all indices, p<0.05).
Conclusion: In MM patients treated with ide-cel, most lived in less DN yet faced significant TD/TT. The marked travel burden overall and the worse responses and inferior OS in patients living in more DN highlight the need to address systemic barriers to improve CAR T access and outcomes.
利益披露 Disclosure
A. R. Richards, None.
J. Y. Islam,
Bristol-Myers Squibb ).
Y. Chen Lin, None.
A. F. Grajales-Cruz,
Bristol Myers Squibb Other, Advisory board.
Cellectar Other, Advisory board.
Janssen Other, Advisory board and Speaker bureau.
Pfizer Other, Advisory board and Speaker bureau.
Sanofi Other, Advisory board and Speaker bureau.
Amgen Other, Speaker bureau.
G. Gonzalez-Calderon, None..
M. Buhlmann, None..
G. DeAvila, None..
D. Scheiber-Camoretti, None..
V. Yin, None.
B. Blue,
Pfizer Pharmaceutics ).
Janssen Pharmaceutics. ).
Oncopeptides ).
Kite Pharmaceuticals ).
Sanofi Pharmaceutics ).
Abbvie Other, Honoraria.
L. B. Oswald,
National Institutes of Health and the Department of Defense ).
B. Kale, None..
D. Kaldas, None..
K. Harada, None..
R. Gonzalez, None.
C. L. Freeman,
Bristol-Myers Squibb ), Other, Honoraria.
Seattle Genetics ), Other, Honoraria.
Cellgene ), Other, Honoraria.
AbbVie ), Other, Honoraria.
Sanofi ), Other, Honoraria.
Incyte ), Other, Honoraria.
ONK therapeutics ), Other, Honoraria.
Janssen ), Other, Honoraria.
Roche/Genentech ).
Amgen ), Other, Honoraria.
H. Liu, None.
F. Perna,
The National Institutes of Health ).
T. Nishihori,
Novartis ).
Karyopharm ).
R. Baz,
Janssen ), Other, Advisory board.
Bristol-Myers Squibb ), Other, Advisory board.
Pfizer Other, Advisory board.
GlaxoSmithKline Other, Advisory board.
Abbvie ).
Karyopharm ).
Regeneron ).
K. H. Shain,
Abbvie ), Other, Honoraria.
Adaptive Other, Honoraria.
Amgen Other, Honoraria.
Bristol Myers Squibb Other, Honoraria.
Janssen Other, Honoraria.
Karyopharm ), Other, Honoraria.
Kite/Arcellx Other, Honoraria.
Regeneron Other, Honoraria.
Sanofi Other, Honoraria.
Sebia Other, Honoraria.
Takeda Other, Honoraria.
Pfizer ).
M. Alsina,
Janssen ), Other, Advisory board.
Bristol-Myers Squibb ), Other, Advisory board.
Pfizer ).
Sanofi ), Other, Advisory board.
F. L. Locke,
A2 ), Advisory.
Allogene ), Advisory.
Amgen ), Other, Advisory.
Bluebird Bio ), Other, Advisory.
Bristol Myers Squibb/Celgene ), Other, Advisory.
Calibr ), Other, Advisory.
Caribou ), Other, Advisory.
Cellular Biomedicine Group ), Other, Advisory.
Cowen ), Other, Advisory.
Daiichi Sankyo ), Other, Advisory.
Iovance ), Other, Advisory.
Kite Pharma ), Other, Advisory.
Janssen ), Other, Advisory.
Legend Biotech ), Other, Advisory.
,Novartis ), Other, Advisory.
Sana ), Other, Advisory.
Takeda ), Other, Advisory.
Wugen ), Other, Advisory.
Umoja ), Other, Advisory.
Pfizer ), Other, Advisory.
O. Castaneda Puglianini,
Legend Biotech Inc ), Other, Honoraria.
Bristol Myers Squibb ), Other, Honoraria.
Janssen Biotech Inc. ), Other, Honoraria.
D. K. Hansen,
Bristol Myers Squibb ), Other, Advisory Role.
Janssen ), Other, Advisory Role.
Legend Biotech Other, Advisory Role.
Pfizer Other, Advisory Role.
Kite Pharma/Gilead Sciences ), Other, Advisory Role.
AstraZeneca Other, Advisory Role.
Karyopharm ), Other, Advisory Role.
Adaptive Biotech ).
The National Institutes of Health ).
L. C. Peres,
Bristol-Myers Squibb ).
Karyopharm ).
Janssen ).
The National Institutes of Health ).
The Department of Defense ).