Geographic Variation and Inequities in Burden and Access to CAR T-Cell Therapies for Multiple Myeloma in the US.

BACKGROUND:Chimeric antigen receptor (CAR) T-cell therapies offer substantial survival benefits for relapsed and/or refractory multiple myeloma (RRMM). However, access remains limited across the US. We examined geographic variation in MM burden and key drivers of CAR T access disparities to inform targeted strategies to close these gaps. PATIENTS AND METHODS:Patients with MM and CAR T recipients from January 2021-August 2024 were identified from the Komodo Patient-Level Analytics and Insights Derivative claims database. MM prevalence at the ZIP-3 level came from the US Cancer Statistics database. Drive-times to the nearest authorized treatment center (ATC) for patients with MM and to ATCs for CAR T recipients were calculated and compared nationally and by region. RESULTS:There were 106,593 prevalent patients over the study period. The South had the second highest MM burden (66.1/100,000 people) but the lowest proportion of patients within 1 hour of an ATC (55.7%). CAR T recipients in the South also traveled the longest to their ATC (median, 1.5 hours). Multivariable analysis with socio-economic and demographic covariates indicated that ≥ 2 hour potential drive-time to nearest ATC versus < 1 hour (adjusted odds ratio [or] = 0.43; 95% confidence interval (CI), 0.27-0.69), household income < $50k versus ≥ $100k (or = 0.19; 95% CI, 0.05-0.69), and residence in nonmetropolitan areas versus metropolitan (or = 0.41; 95% CI, 0.28-0.60) were significantly associated with reduced odds of CAR T use. CONCLUSIONS:There were substantial geographic and socioeconomic disparities in CAR T access, with long drive‑times, lower household income, and non‑metro residence limiting uptake and underscoring the need for targeted ATC expansion.