Breaking Access Barriers to Autologous Stem Cell Transplantation and Chimeric Antigen Receptor T Cell Therapy in Hematologic Malignancies-an ASTCT-NMDP ACCESS Initiative.

Autologous stem cell transplant (ASCT) and chimeric antigen receptor T cell therapy (CAR-T) are approved treatments with curative potential and excellent response rates in patients with aggressive hematologic malignancies. However, multiple barriers hinder the delivery of these treatments, affecting access to patients. Minority patients are less likely to receive ASCT and, when they do, outcomes may not match those of non-minority patients, highlighting the need for accountability and targeted interventions to prevent further widening of disparities. Patient, physician, product, and logistics-related barriers further make lifesaving treatments inequitable. Medicaid and public insurance coverage gaps, as well as social determinants of health, continue to limit access and worsen outcomes for ethnically diverse populations. Additionally, delays and lack of referral from physicians to cellular therapy specialists add to the problem, risking relapse and missed opportunity for these treatments. Addressing these barriers with a sense of urgency, especially in the era of expanding cell therapy indications, could save many patients from succumbing to disease. The American Society of Transplantation and Cellular Therapy (ASTCT) and NMDP (formerly known as the National Marrow Donor Program) collaborate to investigate and address these barriers at a national level. This article highlights treatment barriers and potential strategies to reduce them at individual program and ecosystem levels.