Geographic disparities in availability of advanced therapies for myeloma from rural-urban access limitations: A population-based registry analysis.

e13511 Background: Autologous stem cell transplantation (ASCT) remains standard consolidation therapy for transplant-eligible multiple myeloma (MM) patients. Even though CAR-T therapies have emerged as promising options for relapsed/refractory disease, access remains limited. In Missouri, where 99 of 116 counties are classified as rural, access to both Auto-HSCT and CAR-T therapy remains largely confined to urban populations, potentially resulting in geographic disparities. To evaluate this hypothesis, we studied rural-urban differences in MM incidence, mortality, and access to advanced therapies in Missouri using multi-center registry data supplemented with CAR-T product acquisition information. Methods: A retrospective population-based multi-center analysis was conducted using data from the Missouri Cancer Registry and the BMT InfoNet for MM patients treated between January 2020 and December 2025. Counties were classified as urban (n = 17, including St. Louis City) or rural (n = 99) based on US Census definitions. We analyzed MM incidence and mortality rates (age-adjusted per 100,000 population) by sex, race (White, Black, Other), and geography (rural and urban). Auto-HSCT procedures were analyzed by sex, race, and geography during the study period. CAR-T acquisition data was obtained from centre-reported volumes for Ciltacabtagene autoleucel. Results: Approximately 2,900 MM cases were identified statewide between January 2020 and December 2025. The mean age at diagnosis was 67 years. Incidence was higher in urban (8.9 per 100,000) than in rural counties (5.6 per 100,000). Males had a higher incidence than females (~9.8 vs ~5.6 per 100,000). Black patients had a higher incidence (12-20 per 100,000) compared to White patients (5-8 per 100,000). Rural counties had a higher mortality rate of 4-6 per 100,000 compared to urban counties, which had a rate of 2-4 per 100,000. Mortality was also higher among males, 3-6 per 100,000, and Black patients, 5-7 per 100,000, compared to females, 1.5-3 per 100,000, and White patients, 2-4 per 100,000. There were 1142 autologous transplant procedures statewide during the study period. Auto-HSCT utilization by county of residence was higher in urban than in rural populations (114.6 vs 25.4 procedures per year). Ciltacabtagene autoleucel infusion uptake remained limited to 165 statewide during the 5-year study period, representing 5% of MM patients . Conclusions: Significant geographic disparities in MM care exist in rural-predominant states such as Missouri. Availability of both Auto-HSCT and CAR-T therapies remained limited statewide. These access disparities likely contribute to the observed higher mortality rates in rural counties. These findings underscore the need for health care policy changes addressing geographic barriers to ensure equitable access to advanced MM therapies.