Geographic Gaps Delay CAR T Therapy in Patients With DLBCL
Key Clinical Summary
- Patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) experienced significant delays to CAR T-cell therapy when treated outside the same zip code area as their last PET scan.
- Delays exceeded 6 weeks in some cases, compared with patients treated locally.
- Findings highlight geographic access barriers and potential survival implications tied to treatment timing.
CAR T-cell therapy for relapsed or refractory DLBCL is associated with meaningful survival benefit but requires specialized centers and trained staff. An analysis of US claims data found that geographic discordance between diagnostic and treatment locations was associated with substantial delays in initiating CAR T therapy.
Study Findings
Using January 2018 through March 2024 closed claims data from the Komodo Healthcare Map research network, investigators conducted a case-control study of 767 adults with DLBCL who received CAR T therapy in or after 2019. The primary outcome was time from the last PET scan—used as a proxy for disease progression—to CAR T infusion.
Patients were grouped based on whether they received CAR T therapy in the same zip code tabulation area (ZCTA) as their last PET scan (concordant group) or in a different ZCTA (discordant group). Linear regression models adjusted for age, sex, year of CAR T treatment, Elixhauser comorbidities, and insurance status. Statistical significance was set at a 2-sided P < .05.
Of the total cohort, 512 patients were in the concordant group and 255 in the discordant group. The mean (SD) age at last chemotherapy or transplant was 59.0 (12.9) years in the concordant group and 59.7 (11.3) years in the discordant group. Male patients comprised 62% and 67% of the groups, respectively. No statistically significant demographic differences were observed between groups.
Patients’ last PET scans or treatments spanned 205 ZCTAs across 49 states, while CAR T therapy was delivered in only 88 ZCTAs across 36 states. Investigators found a significant mean delay in time to CAR T therapy among patients treated outside their original ZCTA. At higher percentiles of the time-to-treatment distribution—particularly the 75th and 95th percentiles—differences were more pronounced, suggesting that patients able to wait and travel may still face prolonged access barriers. In some cases, delays exceeded 6 weeks.
Clinical Implications
Life expectancy for patients with DLBCL eligible for CAR T therapy remains limited. Prior research indicates that a substantial proportion of patients die within 12 months of completing first-line therapy in US community practice settings. Moreover, delays as short as 7 to 14 days due to manufacturing constraints have been linked to worse overall survival.
Against this backdrop, the additional delays associated with geographic access barriers may carry clinical consequences. For payers and managed care stakeholders, the findings underscore disparities in site-of-care distribution and referral pathways. CAR T therapy is available in a limited number of centers, concentrated in select ZCTAs and states, creating potential bottlenecks for patients in underserved regions.
The authors suggest that strategies to mitigate access gaps may include streamlining referral processes, expanding CAR T availability to additional treatment centers, and providing logistical support for patients and caregivers. Addressing these barriers may be essential to optimizing outcomes in relapsed or refractory DLBCL.
The investigators noted that “expediting access to curative second-line options is critical,” particularly given evidence that even short delays to CAR T therapy are associated with inferior survival. They emphasized that their study uniquely estimated delays related to limited geographic access and identified an unmet medical need for faster referral and treatment access.
Conclusion
Geographic disparities in access to CAR T-cell therapy are associated with clinically meaningful delays in treatment for patients with relapsed or refractory DLBCL. Efforts to expand treatment capacity and improve referral coordination may be necessary to reduce time to therapy and potentially improve survival outcomes.
Reference
Patel AR, Hsu H, Lau C, et al. Access to chimeric antigen receptor T-cell therapy in patients with diffuse large B-cell lymphoma. JAMA Netw Open. 2025;8;(10):e2538602. doi:10.1001/jamanetworkopen.2025.38602
