Geographic and Racial Disparities in Chimeric Antigen Receptor–T Cells and Bi-specific Antibodies Trials Access for Diffuse Large B-Cell Lymphoma

We investigate the geographical and racial disparities in accessing CAR-T and bispecific antibodies trials for DLBCL. ClinicalTrials.gov was searched, and 75 trials with at least one open site in the US were included. 2020 US Census Bureau data was used to obtain data on race and ethnicity. SPSS version 26 was used for analysis. There were 62 CAR-T and 13 bispecific antibodies trials with 6221 enrolled or expected to enroll patients. 85% of the clinical trials were only open in the US, and the majority 64% were pharmaceutical-funded. There were 126 unique study sites distributed over 31 states with 11 (0-51) mean number of trials per state and 4.5 (1-26) and 4.4 (1-24) mean number of CAR-T and bispecific antibodies trials per site, respectively. Southern states had the most number of trials 31%, followed by Midwestern 25%, Northeastern 24%, and Western 20%. The highest number of study locations were in California 13, New York 9, and Pennsylvania 9, while the highest number of open studies were in California 51, Texas 32, and New York 23. Twenty states had no open CAR-T or bispecific antibodies trials. Only 33% of African Americans (AA) lived in a county with a trial, and seven out of ten states with the highest proportion of AA residents (18.6%-41.4%) have no or less than four trial sites. Of the 62 counties analyzed, 92% were White predominant, while only 8% were AA predominant (p=0.009). Strategies should be framed to address the observed disparities and to improve access.