Impact of racial disparities on efficacy and safety outcomes for patients with RRMM receiving T-cell engagers.

Abstract

e19523 Background: The approval of T-cell engagers (TCEs) for multiple myeloma (MM) has led to prolonged survival, yet baseline health disparities have been shown to contribute to inferior outcomes. TCEs have changed the gold standard of efficacy among patients with relapsed refractory MM (RRMM), with response rates in heavily pretreated patients approaching 60-70% and median PFS ranging between 10 to 22 months. Access to TCEs is not universal due to REMS certification requirement for CRS/ICANS management. We evaluated whether sociodemographic factors influence outcomes with TCEs. Methods: A single center retrospective chart review of consecutive patients with RRMM treated with commercial teclistamab (Tec), talquetamab (Talq), or elranatamab (Elran) between 1/1/23-10/31/24 was performed. Patient demographics, prior treatment, toxicities, and clinical outcomes were extracted from the EMR. Univariate (UV) and multivariate (MV) analyses were used to test associations between sociodemographic and clinical factors. Results: Patients (N=79) who received at least 1 dose of Tec (N=29, 37%), Talq (N=40, 51%), or Elran (N=10, 13%) were evaluated. Of these, 40% were non-white (18% Black, 18% Hispanic) and 22% were non-English speakers. Median income as determined by zip codes was $106,110 and 35% had public insurance. High-risk cytogenetic features were present in 63% of patients, (60% in White, 57% in Black, 71% in Hispanics) and 44% had prior BCMA exposure, with no significant difference among White, Black or Hispanic patients. All patients were triple class exposed and 70% were penta-drug exposed. Median number of prior lines was 5 in whites and non-whites. Income, race, insurance, and age did not affect ORR, PFS, OS, toxicities, or time to treatment initiation in both UV and MV analyses. Non-English speakers showed a trend towards reduced PFS (p=0.072), but this was not statistically significant. Conclusions: Prior data suggested that MM patients with lower incomes, non-white race, and non-English primary languages experience inferior OS. Yet, our findings demonstrated that in a heavily pretreated cohort, differences in race, income, or insurance did not impact ORR, PFS or OS to TCEs. All patients had access to a subspecialty myeloma center. This suggests that despite differences in SES, access to a subspecialty institution, where there are supportive services, multidisciplinary care, and multi-lingual translators, may close the gap in efficacy outcomes. By creating an environment that minimizes financial incentives and fosters support for patients and providers, equitable access to cutting-edge treatments is possible, thereby mitigating systemic inequities and improving outcomes for a diverse RRMM population. Future prospective studies should assess outcomes of patients treated at subspecialty centers compared to the community and aim to increase access to these sites.