Structural Barriers May Limit CAR T-Cell Therapy Access in Myeloma

Access to chimeric antigen receptor (CAR) T-cell therapy for multiple myeloma (MM) may vary significantly depending on where patients receive care and their demographic characteristics. Study researchers, publishing their findings in Cancers, raise questions about potential structural barriers affecting the use of advanced cancer therapies within major health systems.¹

In recent years, CAR T-cell therapy has emerged as a promising approach for patients with relapsed or refractory MM. Findings from clinical trials of B-cell maturation antigen–targeting CAR T-cell therapies have demonstrated promising outcomes, including response rates approaching 98% and progression-free survival lasting several years in some patients. The treatment class was first approved for MM in 2021, when the FDA gave the nod to idecabtagene vicleucel (Abecma; Bristol Myerrs Squibb). A year later, the agency approved ciltacabtagene autoleucel (Carvykti; Johnson & Johnson and Legend Biotech) for the disease.^2-3

Despite these encouraging results, CAR T-cell therapy remains available only at specialized centers capable of managing the treatment’s complex administration and potential adverse effects. Researchers have increasingly questioned whether these logistical limitations may affect which patients ultimately receive the therapy.

To better understand patterns of CAR T-cell access, researchers analyzed electronic health record data from the University of California Health Data Warehouse, a large clinical data repository covering more than 9 million patients across multiple academic medical centers. The retrospective study included more than 12,000 adults diagnosed with MM who received care at University of California facilities between 2012 and 2025 and had undergone at least 1 cancer therapy.

Among this population, only 320 patients—approximately 2.6%—received CAR T-cell therapy. Patients treated at certain academic centers were significantly more likely to receive the treatment, suggesting that differences in institutional infrastructure or referral patterns may play an important role in determining access. In particular, 2 sites functioning primarily as specialty referral centers had higher CAR T-cell therapy utilization rates compared with a location that provided a broader mix of primary and specialty care services.

Patient demographics also appeared to influence treatment patterns. Among patients in the study, the majority were White, with smaller proportions of patients who were Black or African American, Asian, or other racial groups.

After adjusting for disease severity, insurance status, and socioeconomic indicators, Black or African American patients had substantially lower odds of receiving CAR T-cell therapy compared with White patients (OR, 0.33; 95% CI, 0.17-0.62). The researchers noted that these disparities are unlikely to reflect biological differences in treatment eligibility and instead may point to systemic factors affecting access to advanced therapies.

“Our findings suggest that differences in CAR-T receipt may reflect inequitable access to innovative therapies rather than differences in clinical appropriateness,” wrote the researchers, noting that although race was an important factor in the analysis, their findings are likely representative of a broad system of care delivery factors, including trust in the health care system.

Disease burden also played a role in treatment decisions. Patients with a greater number of features that indicate more advanced MM, such as hypercalcemia, renal failure, anemia, or bone disease, were more likely to receive CAR T-cell therapy (OR, 1.43; 95% CI, 1.27-1.62). These findings suggest that clinicians may prioritize CAR T-cell therapy for patients with more aggressive or symptomatic disease.

In addition to analyzing treatment patterns, the researchers used a large language model to review physician clinical notes for a subset of patients treated at 1 medical center. This analysis aimed to determine whether eligible patients had documented discussions about CAR T-cell therapy with their health care providers.

The results revealed that some patients who appeared eligible for CAR T-cell therapy had no recorded discussion about the option in their medical records. This pattern was observed more frequently among Black, Asian, or Pacific Islander patients. Although the study could not determine whether discussions occurred but were undocumented, the findings suggest potential gaps in communication, referral pathways, or documentation practices.

The authors caution that the study has several limitations. Changes in CAR T-cell therapy indications and treatment practices between 2021 and 2025 may influence utilization patterns, and the analysis relied on neighborhood-level socioeconomic data rather than individual measures of financial or social barriers. Additionally, the review of clinical notes was limited to 1 institution and a relatively small patient sample.

References

1. Davidson J, Kumar A, Patel A, Chen IY, Butte AJ, Zack T. Investigating CAR-T treatment access for multiple myeloma patients using real-world evidence. Cancers. 2026;18(4):669. doi:10.3390/cancers18040669
2. FDA approves first cell-based gene therapy for adult patients with multiple myeloma. News release. FDA. March 27, 2021. Accessed March 11, 2026. https://www.fda.gov/news-events/press-announcements/fda-approves-first-cell-based-gene-therapy-adult-patients-multiple-myeloma
3. Carvykti approval marks second CAR T-cell therapy for multiple myeloma. News release. National Cancer Institute. March 30, 2022. Accessed March 11, 2026. https://www.cancer.gov/news-events/cancer-currents-blog/2022/fda-carvykti-multiple-myeloma