Race and Medicine

Race and Medicine

Disclosures: Goldfinger reports no relevant financial disclosures.
May 16, 2022
2 min read
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CAR-T for non-Hodgkin lymphoma effective regardless of race or ethnicity

Disclosures: Goldfinger reports no relevant financial disclosures.
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Black and Hispanic patients who received chimeric antigen receptor T-cell therapy for relapsed or refractory non-Hodgkin lymphoma achieved similar efficacy outcomes as white and Asian individuals, according to study results.

Similar treatment-related toxicities occurred regardless of patients’ race or ethnicity, findings published in Bone Marrow Transplantation showed.

Median survival times.
Data derived from Thakkar A, et al. Bone Marrow Transplant. 2022;doi:10.1038/s41409-022-01670-1.

Background

An analysis to determine possible associations between race/ethnicity and CAR-T outcomes is long overdue, according to Mendel Goldfinger, MD, assistant professor of medicine at Albert Einstein College of Medicine and member of the Montefiore Einstein Cancer Center Cancer Therapeutics Program.

Mendel Goldfinger, MD
Mendel Goldfinger

“We know from other available immunotherapies that the immune response differs — both in the effectiveness and [adverse] effects — among patients of different ethnic backgrounds,” Goldfinger told Healio. “The ability to demonstrate equal efficacy and similar toxicities is something that would truly have an impact on the way we think about designing our clinical trials and our ability to offer these therapies to all people.”

Methodology

Goldfinger and colleagues conducted a retrospective cohort analysis using electronic medical records of 46 patients who received CAR T-cell therapy at Montefiore Medical Center between 2015 and 2021.

Investigators divided patients into two groups. The first comprised 26 Black (n = 9) or Hispanic (n = 17) patients. The second included 20 white (n = 15) or Asian (n = 5) patients.

In the Black/Hispanic group, 24 patients (92%) had diffuse large B-cell lymphoma, and one patient each had follicular lymphoma and mantle cell lymphoma. In the white/Asian group, 17 patients (85%) had diffuse large B-cell lymphoma and three had mantle cell lymphoma.

The study used American Society of Transplantation and Cellular Therapy criteria to evaluate treatment-related toxicities.

Key findings

Researchers found that 58% patients in the Black/Hispanic achieved complete response to therapy compared with 70% of patients in the white/Asian group. Disease progression after CAR-T occurred in 23% of Black/Hispanic patients vs. 10% of white/Asian patients.

Median PFS had not yet been reached among Black/Hispanic patients compared with 11.9 months for white/Asian patients. Median OS was 46.3 months among Black/Hispanic patients but had not been reached among white/Asian patients.

None of differences in efficacy outcomes between the two groups reached statistical significance.

The safety analysis yielded similar rates of grade 1 or grade 2 cytokine release syndrome between the two groups (96% for Black/Hispanic vs. 95% for white/Asian). One patient in each group experienced grade 3 CRS.

Investigators also found similar rates of immune effector cell associated neurotoxicity syndrome (ICANS), with 24 patients (92%) in Black/Hispanic group experiencing grade 1 or grade 2 ICANS compared with 19 patients (95%) in the white/Asian group. Two patients in the Black/Hispanic group and one in the white/Asian group developed grade 3 ICANS.

Clinical implications

The findings show CAR-T is equally effective regardless of a patient’s race or ethnicity, Goldfinger said. Additionally, Black and Hispanic patients have similar treatment-related toxicities as white and Asian individuals, he added.

Goldfinger acknowledged his group’s study cohort was relatively small, yet he believes it is the largest to date to evaluate CAR-T outcomes based on racial and ethnic background.

“This topic needs to be studied prospectively, and we need to evaluate larger data sets that include minorities to more accurately assess the relationship between race and ethnicity and CAR-T outcomes,” he told Healio.

“We are moving more toward more precision immunotherapy, with that precision being specific to each patient's disease biology and — equally as important — specific to each patient's immune milieux and genetic immune makeup,” he added. “Therefore, this study advances the field and has an impact on the way we think about offering CAR-T to minorities.”

F or more information:

Mendel Goldfinger, MD, can be reached at Montefiore Medical Center, 111 E. 210th St., Room 100, Bronx, NY 10467;email: mgoldfin@montefiore.org.