Racial Disparities in CAR T-Cell Therapy Access for Multiple Myeloma

Multiple myeloma (MM) is the second most common hematologic malignancy in the United States, accounting for more than 35,000 new diagnoses annually.¹ The disease disproportionately affects African Americans, who are diagnosed at twice the rate of White patients and, on average, 5 to 10 years earlier.² Despite this elevated burden, African American patients remain significantly underrepresented in clinical trials evaluating novel therapies, including chimeric antigen receptor (CAR) T-cell therapy.³

A new study using real-world evidence from the University of California (UC) Health System sheds important light on the persistence of access disparities and raises urgent questions for pharmacists and oncology care teams regarding the role of race and institutional location in treatment decision-making.

Study Design and Patient Population

Researchers at UC San Francisco (UCSF) analyzed a population-based cohort of 12,360 patients diagnosed with MM who received more than 1 cancer therapy between January 2021 and November 2024, drawing from the UC Health Data Warehouse.¹ Regression models were constructed to evaluate associations of disease severity, UC facility location, and patient demographics with CAR T-cell therapy access, expressed as ORs with 95% CIs.

Of the full cohort, only 320 patients (2.6%) ultimately received CAR T-cell therapy, immediately illustrating the narrow access pipeline.¹ The study also employed GPT-4 in a zero-shot learning framework to analyze clinical notes from UCSF, assessing whether CAR T-cell therapy was discussed, whether patients appeared eligible, and the rationale behind eligibility determinations.

Race and Location as Determinants of Access

The study's findings on racial disparities were striking. African American patients had significantly lower odds of receiving CAR-T cell therapy compared with White patients (OR = 0.33; 95% CI, 0.17–0.62).¹ Patients treated at UC-3, a facility with a predominantly African American patient population, were also less likely to receive CAR-T cell therapy compared with UC-1 (OR = 0.42; 95% CI, 0.30–0.59).¹

These findings align with broader national data. A 2022 study using the Vizient Clinical Database found that African Americans were less likely than all other racial and ethnic groups to receive CAR-T cell therapy, and that only 1% of patients with MM receiving CAR-T cell therapy on a clinical trial were African American.³ Similarly, a 2024 analysis in Blood Advances examining racial and ethnic differences in clinical outcomes among MM patients treated with CAR-T cell therapy found that minority patients faced structural obstacles well before clinical outcomes could even be assessed.⁴

CAR T Eligibility Without Discussion: A Missed Opportunity

The NLP-assisted analysis of UCSF clinical notes identified CAR T-cell therapy eligibility for 270 patients. Among those eligible but lacking discussion, other Pacific Islander patients had the highest rate at 50%, followed by African American patients at 4.2%, Asian patients at 3.2%, and White patients at 0.6%.¹ These findings suggest a gap in provider-initiated conversations around advanced therapy options for racial minority patients, a pattern that has been documented in access research across other hematologic malignancies as well.⁵

The geographic concentration of CAR T–certified treatment centers further compounds access barriers. Industry-sponsored trial sites are disproportionately clustered in affluent metropolitan areas, and prior research has shown that roughly one-third of CAR-T cell therapy recipients live more than 2 hours from the center where they were treated, most of whom had a higher socioeconomic status.³

Implications for Pharmacy and Oncology Practice

As pharmacists and pharmacy teams play a central role in oncology care coordination, the findings from this study underscore an opportunity to actively address disparities in access to CAR T-cell therapy. Pharmacists can play a proactive role in identifying eligible patients during therapy reviews, flagging patients who may benefit from referral to CAR T-certified centers, and supporting insurance navigation—particularly for patients on Medicaid or Medicare, who are underrepresented among CAR T-cell therapy recipients in this cohort.¹ The FDA’s 2024 approvals of idecabtagene vicleucel and ciltacabtagene autoleucel for earlier lines of RRMM represent an expanding window for eligible patients, making equitable identification even more critical.⁵

This study represents an important step toward quantifying real-world inequities in access to CAR T-cell therapy using electronic health record data and artificial intelligence–assisted clinical note analysis. Future work should focus on systemic interventions, including diversifying clinical trial sites, standardizing referral pathways, and integrating equity-focused screening protocols, to ensure that all patients with MM have the opportunity to benefit from this potentially life-altering therapy.

References

1. Davidson J, Kumar A, Patel A, Chen IY, Butte AJ, Zack T. Investigating CAR-T treatment access for multiple myeloma patients using real-world evidence. Cancers (Basel). 2026;18(4):669. doi:10.1101/2025.04.16.25325784

2. Mikhael J, Bhutani M, Cole CE. Multiple myeloma for the primary care provider: a practical review to promote earlier diagnosis among diverse populations. Am J Med. 2023;136(1):33-41. doi:10.1016/j.amjmed.2022.08.030

3. Ahmed N, Shahzad M, Shippey E, et al. Socioeconomic and racial disparity in chimeric antigen receptor T cell therapy access. Transplant Cell Ther. 2022;28(7):358-364. doi:10.1016/j.jtct.2022.04.008

4. Peres LC, Oswald LB, Dillard CM, et al. Racial and ethnic differences in clinical outcomes among patients with multiple myeloma treated with CAR T-cell therapy. Blood Adv. 2024;8(1):251-259. doi:10.1182/bloodadvances.2023010894

5. Mateos MV, Ailawadhi S, Costa LJ, et al. Global disparities in patients with multiple myeloma: a rapid evidence assessment. Blood Cancer J. 2023;13(1):109. doi:10.1038/s41408-023-00877-9