Visualizing Geographic Variation and Systemic Inequities of Disease Burden and CAR T-cell Therapy Access in Multiple Myeloma in the US

Chimeric antigen receptor (CAR) T-cell therapies have emerged as a transformative treatment for relapsed/refractory multiple myeloma (RRMM). Despite substantial survival benefits, access to CAR T remains limited across many US regions, especially in underserved areas. This study characterizes geographic variation in multiple myeloma (MM) burden and identifies key drivers of the disparity in CAR T access to inform targeted strategies in closing access gaps. MM burden from January 2021–August 2024 was estimated using the Komodo Patient-Level Analytics and Insights Derivative (PLAID) claims database. Patients with MM and CAR T recipients were identified using International Classification of Diseases-10 and billing codes, respectively. MM prevalence at ZIP-3 level (first 3 digits of ZIP) was derived from the US Cancer Statistics (USCS) database. Distance and drive-time to the nearest authorized treatment center (ATC) for patients with MM and drive-time to ATCs for CAR T recipients were calculated and compared nationally and by region. There were 106,593 unique prevalent MM cases over the study period. CAR T recipients were slightly younger but otherwise similar to the overall MM population across sex, regions, and insurance type (Table 1). MM burden was highest in the South (66/100,000) and Northeast (67/100,000), with hotspots in Florida, Mississippi, and New Jersey (Fig 1). While 72.9% of patients overall lived within 50 miles of an ATC, this dropped to 67.0% in the South and 66.7% in the Midwest. Median drive-time for CAR T recipients to the ATCs where they received treatment was the longest in the South (1.5 hours) compared to the national estimate (1.3 hours). This suggests CAR T recipients often traveled farther than necessary, since the median drive-time to the nearest ATC was 0.7 hour for patients with MM in general (Fig 2). Supporting this, 36.6% CAR T recipients skipped one of their top three nearest ATCs. CAR T recipients in non-metropolitan areas faced longer median drive-times (2.8 hours) compared to metropolitan areas (1.1 hours). Overall, 15.1% CAR T recipients traveled out-of-state, 2+ hours, and to a non-top three nearest ATC, with this group more likely to be from the South, non-metro areas, and insured under Medicare fee-for-service. This study highlights geographic disparities in MM burden and CAR T access. MM prevalence was highest in the South and Northeast, while access barriers—distance, drive-time, and out-of-state travel—were more pronounced in the South and Midwest. Many CAR T recipients bypassed closer ATCs, indicating systemic or referral-related barriers. These findings highlight areas needing targeted efforts to close access gaps and improve equity in CAR T referral and utilization. Further analyses of sociodemographic drivers of CAR T utilization in RRMM are ongoing and will be presented.