CAR T-Cell Therapy Shows Promise for Multiple Myeloma Despite Access Barriers

CAR T-cell therapy has emerged as a promising approach for patients with relapsed or refractory multiple myeloma, with clinical trials demonstrating response rates approaching 98% and progression-free survival lasting several years in some patients. The treatment class was first approved for multiple myeloma in 2021, when B-cell maturation antigen–targeting CAR T-cell therapies received authorization.

In 2024, the Food and Drug Administration eliminated some barriers to that care to increase patient access. The treatment, called CAR T-cell therapy, uses genetically modified cells to fight the cancer. The process involves collecting, genetically modifying and re-infusing white blood cells to attack the cancer. One treatment takes about two to three months to complete.

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 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 multiple myeloma 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.

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.

"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 multiple myeloma, 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.

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.

New longer-term data from a study show that CARVYKTI, one type of this therapy, doesn't just slow the progression of the disease; it also helps patients live longer. "Historically, the outcome of these patients is pretty poor, with the average survival of under a year," according to clinical observations. The therapy utilizes the patient's own immune cells to act against the cancer cells.

CARVYKTI is an option for multiple myeloma patients when traditional cancer treatments are no longer effective. It's been approved for three years and is being hailed as a major medical breakthrough. Nearly 200,000 people in the United States live with multiple myeloma, a cancer that occurs when a type of white blood cell grows out of control, causing low blood counts, bone and calcium problems, frequent infections and kidney damage.

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.