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. 2025 Jan 28;9(2):429-435.
doi: 10.1182/bloodadvances.2024014171.

Access barriers to anti-CD19+ CART therapy for NHL across a community transplant and cellular therapy network

Minoo Battiwalla  1   2 , Michael Tees  1   3 , Ian Flinn  1   2 , Jeremy Pantin  1   2 , Jesus Berdeja  1   2 , Tara Gregory  1   3 , Michael Maris  1   3 , Vikas Bhushan  1   4 , Estil Vance  1   4 , John Mathews  1   4 , Carlos Bachier  1   5 , Paul Shaughnessy  1   5 , Aravind Ramakrishnan  1   6 , Shahbaz Malik  1   6 , Shahram Mori  1   7 , Casey Martin  8 , Rocky Billups  1 , Betsy Blunk  1 , Charles F LeMaistre  1 , Navneet S Majhail  2
Affiliations

Access barriers to anti-CD19+ CART therapy for NHL across a community transplant and cellular therapy network

Minoo Battiwalla et al. Blood Adv. .

Abstract

We analyzed access barriers to anti-CD19+ chimeric antigen receptor T cells (CARTs) for non-Hodgkin lymphoma (NHL) within a community-based transplant and cell therapy network registry. A total of 357 intended recipients for approved anti-CD19+ CARTs were identified between 2018 to 2022. The median age at referral was 61 years; referral years were 2018 (4%), 2019 (14%), 2020 (18%), 2021 (26%), and 2022 (38%). Diagnoses included diffuse large B cell (69%), follicular (13%), follicular/large (7%), mantle cell (4%), or other (7%). Axicabtagene ciloleucel (62%), tisagenlecleucel (16%), brexucabtagene autoleucel (13%), and lisocabtagene maraleucel (9 %) were infused into 182 patients. The median durations between referral to consultation, consultation to apheresis, and collection to infusion were 11, 107, and 32 days, respectively. The median duration from consultation to CART infusion declined steadily from 207 days in 2019 to 108 days in 2022 (P < .0001). A total of 124 patients (41%) did not receive CART, mostly for disease progression (34%) or poor health (15%). Multivariable logistic regression showed no significant differences in demographic, financial, or social determinants compared with those receiving CART. Notably, the proportion of ineligible patients declined from 53% in 2018-2020 to 34% by 2021-2022 (P = .001). In conclusion, 41% of community patients were unable to access timely CART therapy, mostly due to attrition from disease-related causes, and the overall time to infusion exceeded 4 months. Time to infusion and the proportion receiving CARTs improved over time. Reducing time to apheresis, early referral, and attention to salvage/bridging strategies are necessary.

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Conflict of interest statement

Conflict-of-interest disclosure: All authors report employment with HCA Healthcare.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Time from referral to CART infusion. (A) Time from consultation to infusion. (B) Time from consultation to collection. (C) Time between referral, consultation, collection, and infusion. Median times in days shown categorized by the year of referral, including from referral to consultation, consultation to collection, collection to infusion, as well as consultation to infusion. Error bars show interquartile range. P value for 1-way analysis of variance with test for trend.
See this image and copyright information in PMC

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