CAR-T for all? Barriers, facilitators, and interventions to commercial CAR T-cell therapy access

Chimeric antigen receptor T-cell (CAR-T) immunotherapy has revolutionized the treatment of hematologic malignancies, especially in B-cell acute lymphoblastic leukemia, B-cell non-Hodgkin lymphoma, and multiple myeloma. However, inequitable access to CAR T-cell immunotherapy has been demonstrated among racial and ethnic minority populations. This scoping review examined 37 works of published literature on barriers and facilitators to accessing commercial CAR-T therapy, as well as interventions to mitigate access inequities. The results are organized using the socio-ecological model across patient, provider, institutional, and policy levels, and highlight how these barriers and facilitators can disproportionately affect racial and ethnic minority populations. Barriers are complex and present at all socio-ecological levels, and only two published interventions that target minority access disparities to CAR-T therapy were identified. Key research gaps, including the limited number of barriers supported by objective, primary data and the absence of patient-identified barriers, are discussed. Collectively, the barriers, facilitators, and interventions identified in this scoping review can inform comprehensive, multilevel strategies to eliminate access inequities to commercial CAR T-cell immunotherapy.