Cellular immunotherapies have transformed relapsed/refractory multiple myeloma (RRMM) treatment, achieving high response rates in heavily pretreated populations.1,2 However, optimal implementation requires addressing significant social and economic barriers that limit equitable access and outcomes.3 While ideal candidates demonstrate adequate performance status and preserved organ function, these criteria often intersect with disparities in access that delay or prevent optimal disease management.3
The interval between apheresis and infusion requires careful therapeutic management, with conscious selection of bridging therapy to control disease progression while maintaining CAR T eligibility through tumor burden reduction.2,4 This bridging period demands balancing disease control with preservation of mechanistically diverse options for post-cellular therapy management.
Despite these scientific advancements, socioeconomic factors create disparities in CAR T access. Geographic disparities create substantial inequities as patients from underserved communities face challenges including transportation difficulties, caregiver availability requirements, and proximity to qualified treatment centers.3 This geographic burden extends beyond initial treatment access to include the mandatory post-infusion monitoring period, during which patients must remain near the treatment center. Rural patients face compounded challenges of extended travel, temporary relocation costs, and disruption to local support systems. The potential for outpatient CAR T therapy has the ability to transform access to care for patients nationwide.5
Economic strain remains a major obstacle, even for insured patients. Out-of-pocket expenses including travel costs, lodging for extended periods, lost wages for both patients and caregivers, and expenses for family members providing mandatory post-treatment supervision that often extends up to 30 days following infusion can be prohibitive.4 These costs disproportionately affect lower-income patients and may force families to choose between pursuing potentially curative therapy and maintaining financial stability.
Systemic healthcare factors further compound disparities. Minority patients and those with low socioeconomic status have lower rates of referral for CAR T therapy. Physician-related barriers to CAR T access include inadequate knowledge of efficacy and safety profiles, limited familiarity with treatment management protocols, and delayed referral timing.6 Language barriers, health literacy differences, and cultural factors affecting medical decision-making contribute to differential uptake. Additionally, the complexity of CAR T candidacy evaluation and coordination may overwhelm patients without strong healthcare navigation support or advocacy resources.3,6
Addressing these multilevel barriers requires coordinated interventions. Patient assistance programs, telemedicine for screening evaluations, partnerships with community hotels for subsidized lodging, and dedicated patient navigators can mitigate some access challenges.7 Healthcare systems must also examine referral biases and implement standardized screening protocols to ensure equitable evaluation of all potentially eligible patients regardless of demographic characteristics or socioeconomic status.6
Take our Multiple Myeloma quiz to see how your knowledge compares to your peers.
