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Efficacy and safety of CAR-T cell therapy in minorities

Bone Marrow Transplantation volume 57, pages 1187–1190 (2022)Cite this article

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Chimeric antigen receptor T (CAR-T) cell therapy has revolutionized the treatment of B-cell malignancies. Three CAR-T products targeting CD19 (tisagenlecleucel, axicabtagene ciloleucel, lisocabtagene maraleucel), are now approved for adults with diffuse large B-cell lymphoma (DLBCL) and B-cell precursor acute lymphoblastic leukemia that is relapsed or refractory (R/R) after two or more lines of systemic therapy. Another anti-CD19 CAR-T (brexucabtagene autoleucel) is approved for R/R Mantle Cell Lymphoma. However, none of the registration trials which have led to the approval for CAR-T cells in B-cell malignancies, reported on outcomes for ethnic minority patients [1,2,3,4,5,6]. Most recently, the ZUMA-7 trial reported improved efficacy for CAR-T (axicabtagene ciloleucel), in the second-line setting [7]. Just like earlier CAR-T trials, ZUMA-7 did not report on outcomes for minorities. The lack of minority representation in these practice changing trials poses a challenge when we attempt to extrapolate results in clinical practice, making this an unmet need in the literature. Herein, we present the outcomes of ethnic minority patients (African American and Hispanic) compared to non-minority groups (Caucasian and Other) with non-Hodgkin’s lymphoma that received CAR-T cell therapy at our center.

This is a real-world exploratory retrospective cohort study that captured 46 patients that received CAR-T cells at Montefiore Medical Center between 2015 and 2021. We collected the data including demographics, diagnosis, CAR-T administration and toxicity by chart-level medical record review of Montefiore’s EPIC electronic medical record. All patient information was de-identified. The study was approved by the Institutional Review Board of Albert Einstein College of Medicine/MHS. Statistical analysis was performed using tests appropriate to variable type. A detailed statistical analysis is available in the supplement.

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Fig. 1: Outcomes for minority and non-minority patients receiving CAR-T cell therapy.

Data availability

Data can be available upon request to the corresponding author.

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Acknowledgements

We would like to acknowledge all the physician assistants and nurses on the bone marrow transplant and cellular therapy unit for their compassionate care for these patients. These studies were supported by grants from Izzy Englander, Jane and Myles Dempsey Family, Bristol Myers Squibb Foundation Diversity in Clinical Trials Career Development Program and the Leukemia and Lymphoma Society.

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Author notes

  1. These authors contributed equally: Astha Thakkar, Michelly Abreu, Ira Braunschweig, Mendel Goldfinger.

Authors and Affiliations

  1. Department of Oncology, Montefiore Einstein Cancer Center, Blood Cancer Institute, Montefiore Medical Center, Bronx, New York, NY, USA

    Astha Thakkar, Michelly Abreu, R. Alejandro Sica, Aditi Shastri, Noah Kornblum, Nishi Shah, Ioannis Mantzaris, Kira Gritsman, Eric Feldman, Richard Elkind, Amit Verma, Ira Braunschweig & Mendel Goldfinger

  2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, NY, USA

    Kith Pradhan

  3. Montefiore Health System, Bronx, New York, NY, USA

    Susan Green-Lorenzen

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  1. Astha Thakkar
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Contributions

Conception and design: AT, MG, AV, Data collection: MA, AT, Statistical analysis: KP, Initial manuscript draft: AT, MG, Manuscript revision: All authors. All authors have reviewed and approved the final version of the manuscript.

Corresponding authors

Correspondence to Ira Braunschweig or Mendel Goldfinger.

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Competing interests

AV has received research funding from Prelude, BMS, GSK, Incyte, Medpacto, Curis and Eli Lilly and is a scientific advisor for Stelexis, Novartis, Acceleron and Celgene and received honoraria from Stelexis and Janssen and holds equity in Stelexis and Throws Exception. KG has received research funding from ionctura, SA and ADC therapeutics. AS has received honorarium from GLG, Guidepoint, Onclive, consultation fee from Janssen Pharmaceuticals, advisory board fee from Rigel Pharmaceuticals, research funding from Kymera Therapeutics. AT, MA, KP, RAS, NK, NS, IM, EF, SGL, RE, IB and MG have nothing to disclose.

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Thakkar, A., Abreu, M., Pradhan, K. et al. Efficacy and safety of CAR-T cell therapy in minorities. Bone Marrow Transplant 57, 1187–1190 (2022). https://doi.org/10.1038/s41409-022-01670-1

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