Relationship between Neighborhood-Level Socioeconomic Status and Relapsed Pediatric B-Acute Lymphoblastic Leukemia Treated with CAR-T19 Therapy in Indiana

Abstract

Background/Purpose: There is paucity of studies investigating the relationship between socioeconomic status and outcomes for patients receiving chimeric antigen receptor T-cell therapy (CART19) for refractory or relapsed B-ALL. Area Deprivation Index (ADI) serves as a measurement of socioeconomic disadvantage based on theoretical income, education, employment, and quality of housing. Methods: A retrospective chart review of 27 patients with relapsed B-ALL treated with CART19 at a non-profit children’s hospital from 2018-2024 was conducted. Using a public institution’s Neighborhood Atlas database, ADI scores (range 1-10) were recorded for each patient based on ZIP code of residence in Indiana. A low ADI score (0-5) indicates affluence and higher SES, while a high ADI score (6-10) indicates deprivation and a lower SES. Comparisons between groups were done using Chi-square tests for categorical variables. The Kaplan-Meier method was used to analyze relapse free survival (RFS) using the log rank test to compare groups. Results: The patients (age range 2-25 years) were stratified into two groups: low ADI or high SES (≤5, n = 10 (37%); 2.9 ± 1.4; range, 1-5)) and high ADI or low SES (>5, n = 17 (63%); 8.5 ± 1.5; range, 6-10). Seventeen identified as white (63%) and 10 (37%) as Hispanic. Three patients received CART19 infusions twice, and one patient received multiple CART19-directed products. In the high ADI group, 3-month, 6-month, and 1-year RFS post-CART therapy was 82%, 76%, 60% respectively compared to 100%, 71%, 57% in the low ADI group (p=0.9). Conclusion: Most patients who received CART therapy at our tertiary center resided in low SES areas but did not experience worse RFS compared to patients residing in more affluent areas. Further studies with larger sample sizes are needed to better understand the heath inequalities among patients with relapsed leukemia in Indiana and to identify challenges faced by patients from disadvantaged communities with limited resources.