What population-based databases reveal about equity in access to hematopoietic cell transplant and cellular therapy.

BACKGROUND

Large population-based databases are increasingly used to study access to hematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy.

METHODS

We conducted a systematic scoping review of studies using US databases (1/2008-2/2025) to examine access to HCT or CAR-T therapy for hematologic malignancies to identify limitations and explain differences in reported disparities.

RESULTS

Thirty-five studies met inclusion criteria, and 46% used linked databases. Across data sources, older age, racial and ethnic minoritized status, lower neighborhood socioeconomic status, and non-private insurance were associated with lower likelihood of HCT and CAR-T receipt. However, disparities varied substantially by databases due to differences in eligible populations, data availability, and ability to identify treatment candidacy.

CONCLUSION

No single database adequately characterizes disparities in access to cellular therapies. Equity-focused research requires deliberate alignment of research questions with database strengths and greater investment in data standardization and inclusion of social determinants of health.