Short-term financial toxicity in CAR T-cell therapy.

Abstract

e23264 Background: While chimeric antigen receptor T-cell therapy (CAR-T) is remarkably efficacious in achieving remissions, limited prospective data exists on financial toxicity (FT) during therapy. We report interim results from an ongoing prospective study at the University of Minnesota investigating FT and out-of-pocket (OOP) costs in adult commercial CAR-T recipients. Methods: Patients completed a survey before apheresis (baseline), D+30, and D+90 post CAR-T assessing self-reported sociodemographic factors, OOP costs, and FT. FT was measured by the validated Comprehensive Score for Financial Toxicity (COST) score and defined as COST score < 26. Results: From 01/2025 to 01/2026, 116 pts were screened and 50 enrolled. Out of 25 pts who completed the study, the median age was 69 (39-87) and 18 (72%) were retired. One had acute lymphoblastic leukemia, 13 had multiple myeloma, and 11 had lymphoma. Ten (40%) were females. One had Medicaid, 16 had Medicare, and 8 had commercial insurance. Twelve (48%) had a bachelor’s degree or higher, and 17 (77%) had an annual income > 65,000. At baseline, D+30, and D+90, 7 (28%), 8 (33.3%), and 7 (31.8%) pts reported FT (COST score < 26), respectively. One and 3 COST scores were missing at D+30 and D+90, respectively, due to loss to follow-up or death. Baseline COST scores were used to define FT groups using an optimal cutoff identified by classification tree analysis ( < 33 vs. ≥33). Patients with baseline COST scores ≥33 had higher odds of improved or stable FT status at D+90 compared to those with baseline scores < 33 (odds ratio [OR] = 12.6, 95% CI 1.19–133.8). Change in COST score from baseline to D+90 (ΔCOST) differed by baseline group. Among pts with baseline scores < 33 (n = 8), the mean change was 4.25 (SD 3.33), with a median of 4.5 (IQR 3, 6.5). In contrast, pts with baseline scores ≥33 (n = 14) had a mean change of –0.19 (SD 7.44), with a median of –2.65 (IQR –5.5, 5.5). This difference in ΔCOST between the two groups was marginally statistically significant based on the Wilcoxon rank-sum test (p = 0.091). Among those with baseline COST score < 33, median age was 68, average income was 144K, 10 (71%) had Medicare, and 8 (57%) had a complete response (CR). Among those with baseline scores >33, median age was 68, average income was 222K, 5 (62%) had Medicare, and 8 (100%) achieved a CR. Median cumulative OOP cost at D+90 was $610 (IQR: $247.5–$2280). Largest OOP costs by category were living accommodations (33.8%), medications (27.1%), doctors/hospital visits (19.9%), travel/parking (9.6%), and other costs (9.6%). Conclusions: In our cohort of predominantly well-insured, high-earning, and educated pts, 28% experienced FT throughout the first 3 months, highlighting short-term FT as a challenge in a subset of pts after CAR-T. Those with baseline COST score >33 had 12.6-fold higher odds of being improved/stable at D+90 compared with those with scores < 33. This cutoff may help to identify low vs. high-risk patients who may benefit from financial navigation.