The use of chimeric antigen receptor T-cell (CAR-T) therapy was linked to similar overall survival (OS) rates, regardless of differences in household poverty and neighborhood opportunity, in a recent study involving children and young adults with relapsed/refractory (r/r) acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LLy). Study results were reported in the journal Blood.
The study investigators evaluated data from across 5 clinical trials involving the use of CD19-targeted CAR T cells in patients with ALL or LLy who were from 1 to 29 years of age. Treatment was administered at the Children’s Hospital of Philadelphia, Pennsylvania, between April 2012 and December 2020. OS was the primary outcome of this study, which was analyzed in the context of estimates of household poverty and neighborhood poverty in these patients. A secondary outcome was relapse-free survival (RFS).
Insurance status was used to estimate household poverty, and patients receiving public insurance, in the form of Medicaid or the Children’s Health Insurance Program, were considered poverty exposed. Neighborhood opportunity was estimated using the 2015 Childhood Opportunity Index 2.0, which is based on factors like education, health/environment, and social/economic features. The median study follow-up duration was 46 months.
Household poverty was identified in 35.9% of the 206 patients evaluated in this study who were treated with CAR T therapy for ALL or LLy. A low level of neighborhood opportunity was identified in 24.9%. Household poverty did not appear associated with complete remission (CR) in patients of this study (P =.334), and level of neighborhood opportunity also did not show a significant relationship with CR (P =.504). The CR rate was 93.2% for the total population.
OS rates did not appear to be significantly related to household poverty or neighborhood opportunity. The 36-month OS rate was 73.8% (95% CI, 64.3-84.7) for patients exposed to poverty, compared with 67.7% (95% CI, 60.0-76.4) for those unexposed to poverty (P =.483). In an adjusted analysis, the hazard ratio (HR) for OS with poverty exposure was 1.0 (95% CI, 0.5-2.0; P =.971).
Similarly, the 36-month OS rate was 72.6% (95% CI, 60.8-86.6) for patients in areas of low neighborhood opportunity, compared with 70.7% (95% CI, 63.7-78.5) for those in areas of high neighborhood opportunity (P =.724). The adjusted HR for OS by low versus high neighborhood opportunity was 1.2 (95% CI, 0.6-2.4; P =.545).
RFS also appeared to be unaffected by household poverty level in this study (adjusted HR, 0.7; 95% CI, 0.4-1.3; P =.273). However, patients in low-opportunity neighborhoods showed a higher risk of relapse, compared with those in high-opportunity neighborhoods (adjusted HR, 2.3; 95% CI, 1.3-4.1; P =.006).
“Neither household poverty nor low-neighborhood opportunity are associated with CR or OS in a cohort of children with ALL or LLy who received CAR T-cell therapy at a tertiary care center,” the study investigators wrote in their report.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Newman H, Li Y, Liu H, et al. Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy. Blood. 2023;141(6):609-619. doi:10.1182/blood.2022017866