14 November 2022

The success of relapsed/refractory acute lymphoblastic leukaemia (ALL) treatment with CAR T-cell therapy is equal, regardless of socioeconomic background, according to a new analysis.

The research, by a team at Children’s Hospital of Philadelphia (CHOP), Pennsylvania, USA, confirmed that overall, children with ALL living in poverty are significantly more likely to relapse and die from their disease than those from wealthier backgrounds. However, they discovered that among children with relapsed/refractory ALL treated with CAR T-cell therapy there is no difference in survival between socioeconomic groups.

CAR T-cell therapy has been proven to be successful in improving outcomes for those with ALL, but it can be expensive, time-intensive, and largely out of reach for many marginalised groups.

Previous research has claimed that because marginalised groups have lower overall survival rates, they may be less likely to fare well with CAR T-cell therapy. However, the researchers say their new findings refute that claim.

Dr Haley Newman, from the division of oncology and cancer immunotherapy program at CHOP, said: “What we see here is that among this cohort, CAR T-cell therapy is equally effective regardless of poverty exposure. This study suggests that CAR T-cell therapies work equivalently.”

Dr Newman and colleagues studied the outcomes of 206 children and young adults who were treated at CHOP. The cohort had a median age of 12.5 years and had reduced/refractory ALL treated on one of five CAR T-cell clinical trials or with a commercial CAR-T, tisagenlecleucel (Kymriah).

Data was collected from CAR T-cell clinical trial datasets and electronic medical records from patients treated between April 2012 and December 2020. Patients were sorted by socioeconomic and neighbourhood opportunity exposures, which they determined using insurance types and patient addresses.

“Many previous neighbourhood studies have sorted data at the zip code level,” said Dr Newman. “We actually had address data for these patients, which allowed us to geocode their census tract, which is the level at which the childhood opportunity index is measured.”

Results revealed no significant difference in overall survival or complete remission rates between household-poverty exposed patients with lower neighbourhood opportunity and those from more advantaged households.

The data also demonstrated that children from more advantaged households were significantly more likely to present with high disease burden at the time of referral for CAR T-cell infusion.

Dr Allison Barz Leahy, an oncologist in the division of oncology at CHOP, said: “We can’t say exactly why we’re seeing a difference in disease burden, but it could be due to provider referral biases, families from more advantaged households having more resources to access CAR-T and more flexibility to take time off work for treatments or there may be a difference in how families are able to advocate for their children to receive this therapy.”


Newman H, Li Y, Liu H, Myers RM, Tam V, DiNofia A, Wray L, Rheingold SR, Callahan C, White C, Baniewicz D, Winestone LE, Kadauke S, Diorio C, June CH, Getz K, Aplenc R, Teachey DT, Maude SL, Grupp SA, Bona K, Barz Leahy A. (2022) “Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy.” Blood, doi:10.1182/blood.2022017866

Link: https://ashpublications.org/blood/article-abstract/doi/10.1182/blood.2022017866/487056/Impact-of-poverty-and-neighborhood-opportunity-on

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