Abstract B160: Racial disparities in CAR T-cell therapy utilization and outcomes among patients with diffuse large B-cell lymphoma: A matched cohort study

Abstract Background: Despite the transformative potential of chimeric antigen receptor (CAR) T-cell therapy in treating relapsed/refractory diffuse large B-cell lymphoma (DLBCL), racial disparities in access and clinical outcomes remain inadequately characterized. This study evaluates utilization patterns and clinical outcomes among Black and White patients treated with CAR T-cell therapy using robust real-world data. Methods: We conducted a retrospective analysis using data from the TriNetX US Collaborative Network, which includes electronic medical records from 67 healthcare organizations. Adult patients with DLBCL receiving CAR T-cell therapy were identified and stratified by race (Black or White). Propensity score matching was performed (1:1) based on 17 demographic, diagnostic, medication, and laboratory variables, yielding matched cohorts of 218 Black and 218 White patients. Outcomes evaluated within one year included all-cause mortality, hospitalization, ICU admission, emergency department (ED) visits, and chronic comorbid conditions such as hypertension, diabetes, and cardiovascular diseases. Results: Initially, 223 Black patients (9.4%) and 2,380 White patients received CAR T-cell therapy, highlighting significant racial disparities in access relative to national DLBCL prevalence rates. Following propensity score matching, both cohorts had comparable baseline characteristics. Survival analysis demonstrated a numerically lower mortality risk among Black patients (22.2%) compared to White patients (28.6%), though not statistically significant (HR 0.73, 95% CI 0.50–1.07, log-rank p = 0.103). Kaplan-Meier estimates indicated a 12-month survival of 75.1% for Black patients versus 67.4% for White patients. Rates of ICU admission (18.9% Black vs. 22.4% White; p=0.401), hospitalization (85.7% vs. 80.8%; p=0.579), and ED visits (13.4% vs. 14.7%; p=0.757) were similar between groups. Evaluation of chronic conditions revealed no significant differences in hypertension, coronary artery disease, heart failure, diabetes, deep vein thrombosis, or pulmonary embolism occurrences. However, osteoporosis rates were significantly lower among Black patients (0%) compared to White patients (4.8%, p=0.001). Conclusions: Black and White patients receiving CAR T-cell therapy for DLBCL exhibited comparable short-term clinical outcomes following rigorous matching. Nevertheless, significant underrepresentation of Black patients highlights persistent systemic inequities in access to advanced cellular therapies. Targeted interventions, including inclusive referral processes, enhanced financial and logistical support, and community-focused outreach, are urgently required to mitigate disparities and ensure equitable therapeutic access. Citation Format: Chidiebube Ugwu, George Laliotis, Muluken Megiso, Sam King. Racial disparities in CAR T-cell therapy utilization and outcomes among patients with diffuse large B-cell lymphoma: A matched cohort study [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B160.