PO.PS01.04 · 人群科学
社区弱势、出行距离和出行时间对接受idecabtagene vicleucel治疗的多发性骨髓瘤患者临床结局的影响
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
中文摘要
目的：探讨社区弱势与出行距离（TD）/时间（TT）与接受首个多发性骨髓瘤（MM）嵌合抗原受体T细胞疗法（CAR T）idecabtagene vicleucel（ide-cel）治疗的MM患者临床结局之间的关联。
方法：纳入了截至2024年7月在Moffitt癌症中心接受ide-cel治疗的MM患者。社区弱势采用地区剥夺指数（ADI）、社会剥夺指数（SDI）和社会脆弱性指数（SVI）定义，数值越高表示社区越弱势（DN）。从患者住所到Moffitt的TD/TT通过Google Directions API计算。使用卡方检验、log-rank检验和Kaplan-Meier曲线，以上四分位数为切点，按各指数和TD/TT比较患者特征、安全性和疗效。采用多变量logistic回归和Cox回归分别检验各指数和TD/TT与ide-cel疗效和生存的关联，并校正相关协变量。
结果：在173名接受ide-cel治疗的MM患者中，大多数为男性（54%）、非西班牙裔白人（73%）且年龄>60岁（75%）。中位随访时间为12.6个月（范围0.1-38.4）。中位ADI为42（范围1-96），SDI为38（范围1-100），SVI为0.7（范围0.1-1.0）。居住在更弱势与较不弱势社区的患者相比更年轻（所有指数，p<0.05），更可能为黑人（SDI：37% vs 10%，p<0.001），既往接受过自体干细胞移植（ADI：80% vs 61%，p=0.02），以及有髓外病变（ADI：32% vs 14%，p=0.01）。SVI较高的患者更可能发生感染（44% vs 25%，p=0.02），且较不可能达到完全缓解（CR）或更佳缓解（44% vs 63%，p=0.03）。居住在更弱势与较不弱势社区的患者总生存期（OS）较差（SDI：中位27个月 vs 未达到，p=0.04；SVI：中位18个月 vs 未达到，p=0.01）。在多变量模型中，居住在更弱势与较不弱势社区的患者较不可能达到CR或更佳缓解（SDI：比值比[OR]=0.39，95%置信区间[CI]=0.16-0.91；SVI：OR=0.40，95% CI=0.17-0.90），且OS更差（SDI：风险比[HR]=1.78，95% CI=0.97-3.28；SVI：HR=2.14，95% CI=1.16-3.95）。按DN未观察到其他结局差异。中位TD和TT分别为76.5英里（范围2.5-1079.6）和90分钟（范围10-1022）。除出行距离/时间较长的患者更可能具有高危细胞遗传学（58% vs 28%，p<0.001）外，按TD/TT未发现患者特征或临床结局的差异。来自更弱势社区的患者TD/TT较短（所有指数，p<0.05）。
结论：在接受ide-cel治疗的MM患者中，大多数居住在较不弱势的社区，但仍面临显著的TD/TT。总体上明显的出行负担，以及居住在更弱势社区患者更差的缓解和更差的OS，凸显了解决系统性障碍以改善CAR T可及性和结局的必要性。
查看英文原文 English 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 ).