Race, ethnicity, and body mass index (BMI) do not have a significant impact on chimeric antigen receptor (CAR) T-cell therapy efficacy or neurotoxicity outcomes in heavily pretreated patients with B-cell acute lymphoblastic leukemia (B-ALL); however, Hispanic patients are more likely than patients of other races/ethnicities to experience severe cytokine release syndrome following CAR T-cell therapy, according to research published in Blood Advances.
Researchers retrospectively evaluated the impact of demographics and obesity on CAR-T therapy outcomes in patients with hematologic malignancies, focusing primary on young adult and pediatric patients with B-ALL, treated with CAR T-cell therapy across 5 phase 1 clinical trials at the National Cancer Institute between 2012 and 2021.
A total of 139 patients with B-ALL (median age, 15.10 years; interquartile range, 9.55-21.20) received CAR T-cell infusions. The patient population was 57.1% non-Hispanic White, 28.8% Hispanic, and 3.6% Black, and 29.5% overweight/obese.
Overall, the investigators observed complete remission in 67.6% and neurotoxicity in 20.9% of patients, and they reported a median overall survival of 12.2 months. They found no significant associations between race/ethnicity, sex, or BMI and complete remission rates, neurotoxicity, or overall survival.
After adjusting for leukemia disease burden and age in a multivariable analysis, the team found that Hispanic patients were more likely to experience severe cytokine release syndrome compared with White non-Hispanic patients (odds ratio, 4.5; P =.001). They observed a similar trend in a descriptive analysis of patients with multiple myeloma (n=24) and non-Hodgkin lymphoma (n=23).
“Our findings suggest CAR T-cell therapy may provide substantial benefit across a range of demographics characteristics; [however,] toxicity profiles may vary,” the researchers concluded in their report. “Although our results highlight the potential of CAR T-cell therapy to improve outcomes in populations who have worse chemotherapy outcomes, it is important to recognize combating cancer health disparities will require a multifaceted approach that incorporates not only better access to emerging therapies such as CAR T cells but also improved prevention and relapse mitigation strategies.”
Limitations of the study included the retrospective design, small sample size overall and among subgroups, infeasibility of assessing the association of obesity with cancer outcomes, and inability to account for socioeconomic status.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures.
Faruqi AJ, Ligon JA, Borgman P, et al. The impact of race, ethnicity, and obesity on CAR T-cell therapy outcomes. Blood Adv. 2022;6(23):6040-6050. doi:10.1182/bloodadvances.2022007676