Do SDOH Drive Survival Outcomes With Brexu-Cel in ALL?

Black patients with relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL) receiving brexucabtagene autoleucel (brexu-cel) had significantly worse overall survival (OS), while Hispanic patients and those facing high social deprivation experienced outcomes comparable with non-Hispanic patients, according to a new study.¹

This retrospective analysis is published in Bone Marrow Transplantation.

The researchers believe the study highlights the impact of race and social deprivation on survival outcomes in patients with R/R B-ALL receiving brexu-cel. | Image credit: DeisgnCells - stock.adobe.com

“To our knowledge, this multicenter retrospective analysis is the first to assess racial, ethnic, and SDOH [social determinants of health] differences as they relate to the safety and outcomes of brexu-cel for R/R B-ALL outside of a clinical trial setting,” wrote the researchers of the study.

Previous literature has suggested that Black and Hispanic patients with ALL experience inferior survival compared with other racial groups.² Despite overall improvements in survival across all age groups and ALL subtypes, these disparities highlight persistent racial and socioeconomic gaps in treatment outcomes.

The study included adults aged 18 years or older with R/R B-ALL who received brexu-cel between 2021 and 2023. Patient demographic, clinical, and social determinants of health (SDOH) data, including race, ethnicity, insurance type, distance from the chimeric antigen receptor (CAR) T treatment center, referral source, and social deprivation index (SDI), were collected from medical records.

Additionally, the researchers evaluated associations between race, ethnicity, SDOH factors, and survival outcomes, specifically progression-free survival (PFS) and OS. Furthermore, subgroup analyses were conducted to assess the independent impact of SDOH on survival outcomes while controlling for relevant clinical covariates.

Among the adults treated with brexu-cel, 57% were male, 55% were non-Hispanic White, 30% were Hispanic, 7% were non-Hispanic Black, 6% were Asian/Pacific Islander, and 2% were other/unknown. Forty-three percent were referred from community-based practices, 35% lived 50 miles or more from the CAR T center, and 31% had a high SDI (76th-99th percentile).

Black race was associated with worse OS (HR, 3.48; 95% CI 1.01-12.03). For Hispanic patients, there was no significant difference in PFS (HR, 1.03; 95% CI 0.50-2.10) or OS (HR, 1.43; 95% CI 0.56-3.65) compared with non-Hispanic patients.

Overall, outcomes appeared largely independent of SDOH, including insurance type, distance from the treatment center, and social deprivation, indicating that brexu-cel efficacy was not significantly impacted by these factors.

However, the researchers note several study limitations. First, the study may have misclassified socioeconomic status by using zip code–level SDI rather than more precise measures. It also excluded patients eligible for CAR T therapy who were never referred or did not receive infusion, leaving barriers to access unexamined. Therefore, the researchers acknowledged that further research is needed to identify factors affecting access among all CAR T–eligible patients.

Despite these limitations, the researchers believe the study highlights the impact of race and social deprivation on survival outcomes in patients with R/R B-ALL receiving brexu-cel.

“We found no difference in PFS or OS in Hispanic patients and no difference in OS based on SDOH factors,” wrote the researchers. “Receiving CAR T therapy may eliminate some of the historical disparities in outcomes seen in patients with B-ALL. Ensuring equal access to these advanced therapies is critical to promoting equity in health outcomes for all patients with R/R B-ALL.”

References

1. O’Connor T, Lin C, Roloff, GW, et al. The impact of social determinants of health on outcomes of brexucabtagene autoleucel in adults with relapsed/refractory B-cell acute lymphoblastic leukemia. Bone Marrow Transplant (2025). doi:10.1038/s41409-025-02693-0

2. Sasaki K, Jabbour E, Short NJ, et al. Acute lymphoblastic leukemia: A population-based study of outcome in the United States based on the surveillance, epidemiology, and end results (SEER) database, 1980-2017. Am J Hematol. 2021;96(6):650-658. doi:10.1002/ajh.26156