{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T11:34:55Z","timestamp":1781177695828,"version":"3.54.1"},"reference-count":41,"publisher":"American Society of Hematology","issue":"6","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Children living in poverty experience excessive relapse and death from newly diagnosed acute lymphoblastic leukemia (ALL). The influence of household poverty and neighborhood social determinants on outcomes from chimeric antigen receptor (CAR) T-cell therapy for relapsed\/refractory (r\/r) leukemia is poorly described. We identified patients with r\/r CD19+ ALL\/lymphoblastic lymphoma treated on CD19-directed CAR T-cell clinical trials or with commercial tisagenlecleucel from 2012 to 2020. Socioeconomic status (SES) was proxied at the household level, with poverty exposure defined as Medicaid-only insurance. Low-neighborhood opportunity was defined by the Childhood Opportunity Index. Among 206 patients aged 1 to 29, 35.9% were exposed to household poverty, and 24.9% had low-neighborhood opportunity. Patients unexposed to household poverty or low-opportunity neighborhoods were more likely to receive CAR T-cell therapy with a high disease burden (&amp;gt;25%), a disease characteristic associated with inferior outcomes, as compared with less advantaged patients (38% vs 30%; 37% vs 26%). Complete remission (CR) rate was 93%, with no significant differences by household poverty (P\u00a0= .334) or neighborhood opportunity (P\u00a0= .504). In multivariate analysis, patients from low-opportunity neighborhoods experienced an increased hazard of relapse as compared with others (P\u00a0= .006; adjusted hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.3-4.1). There was no difference in hazard of death (P\u00a0= .545; adjusted HR, 1.2; 95% CI, 0.6-2.4). Among children who successfully receive CAR T-cell therapy, CR and overall survival are equitable regardless of proxied SES and neighborhood opportunity. Children from more advantaged households and neighborhoods receive CAR T-cell therapy with a higher disease burden. Investigation of multicenter outcomes and access disparities outside of clinical trial settings is warranted.<\/jats:p>","DOI":"10.1182\/blood.2022017866","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T21:27:03Z","timestamp":1668029223000},"page":"609-619","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":33,"title":["Impact of poverty and neighborhood opportunity on outcomes for children treated with CD19-directed CAR T-cell therapy"],"prefix":"10.1182","volume":"141","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3022-8052","authenticated-orcid":false,"given":"Haley","family":"Newman","sequence":"first","affiliation":[{"name":"1Division of Oncology and Cancer Immunotherapy Program, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimei","family":"Li","sequence":"additional","affiliation":[{"name":"1Division of Oncology and Cancer Immunotherapy Program, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"},{"name":"4Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"7Center for Childhood Cancer Research, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Liu","sequence":"additional","affiliation":[{"name":"5Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2542-2061","authenticated-orcid":false,"given":"Regina M.","family":"Myers","sequence":"additional","affiliation":[{"name":"1Division of Oncology and Cancer Immunotherapy Program, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"},{"name":"3Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicky","family":"Tam","sequence":"additional","affiliation":[{"name":"5Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"DiNofia","sequence":"additional","affiliation":[{"name":"1Division of Oncology and Cancer Immunotherapy Program, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"},{"name":"3Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"7Center for Childhood Cancer Research, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Wray","sequence":"additional","affiliation":[{"name":"1Division of Oncology and Cancer Immunotherapy Program, Children\u2019s Hospital of Philadelphia, 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CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2996-8034","authenticated-orcid":false,"given":"Stephan","family":"Kadauke","sequence":"additional","affiliation":[{"name":"8Division of Transfusion Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"},{"name":"9Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Diorio","sequence":"additional","affiliation":[{"name":"1Division of Oncology and Cancer Immunotherapy Program, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0241-3557","authenticated-orcid":false,"given":"Carl H.","family":"June","sequence":"additional","affiliation":[{"name":"6Parker Institute for Cancer Immunotherapy, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly D.","family":"Getz","sequence":"additional","affiliation":[{"name":"3Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"4Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7482-5644","authenticated-orcid":false,"given":"Richard","family":"Aplenc","sequence":"additional","affiliation":[{"name":"1Division of Oncology and Cancer Immunotherapy Program, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"},{"name":"3Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA"},{"name":"7Center for Childhood Cancer Research, Children\u2019s Hospital of Philadelphia, Philadelphia, 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