Patient access to CAR T-cell therapy: a mismatch between eligible patients and actual patients treated
Despite the potential of CAR T-cell therapies, a large proportion of eligible patients struggle to access them.
A real-world retrospective study observed that between 2022 and 2024, only 25% of eligible LBCL patients (n=205) deemed fit for second line CAR T-cell therapy received treatment, and non-curative intent treatments were often used instead.59 A 2022 survey of US CAR T treatment centers (n=17) also revealed that only 25% of patients with MM referred for CAR T-cell therapy are believed to receive the treatment.60
In Europe, a 2020 comparative analysis study estimated that across France, Germany, Italy and Spain, an average of only 33% of third line and beyond relapsed or refractory LBCL patients received CAR T-cell therapy. The rate varied considerably across countries, with an average of 17% in Italy and 42% in France.6 A recent IQVIA Institute report assessing Australia, Canada, France, Germany, Italy, Spain and the UK found that only 13% of relapsed or refractory large B-cell lymphoma patients who had beyond two lines of therapy received CAR T-cell therapy in 2022, within the EU countries and UK combined. The rate rose to just 18% in 2023.61 Analysis in Germany using a patient-level simulation also found that an estimated 21% of potentially eligible LBCL patients (n=2191) were misallocated to another treatment approach due to clinical and non-clinical reasons, leading to reduced overall survival.62
In short, there are still too many barriers preventing eligible patients from accessing CAR T-cell therapy. These barriers can be summarized under the three following areas:
- Awareness and understanding of CAR T-cell therapy
- Resources and capacity for CAR T-cell therapy
- Sustainable and innovative financing approaches to manage the costs of treatment and care
The next section brings focus to areas where there are opportunities for change, outlining the strategic imperatives that support and drive that change.
References
6 Xu J, Wang BY, Yu SH, et al. Long-term remission and survival in patients with relapsed or refractory multiple myeloma after treatment with LCAR-B38M CAR T cells: 5-year follow-up of the LEGEND-2 trial. J Hematol Oncol. 2024;17(1):23. Published 2024 Apr 24. doi:10.1186/s13045-024-01530-z.
59 Perales MA, McGuirk JP, Fesen MR, et al. Real-World Treatment Patterns of Large B-Cell Lymphoma Patients over Time in a Post-CAR T Approval Era. Transplant and Cell Ther. 2025;31(2):Supplement
60 Kourelis T, Bansal R, Patel KK, et al. Ethical challenges with CAR T slot allocation with idecabtagene vicleucel manufacturing access. J Clin Oncol. 2022; 40(16):Supplement
61 IQVIA. Achieving CAR-T Cell Therapy Health System Readiness. 2025. Available online: https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/achieving-car-t-cell-therapy-health-system-readiness
62 Buecklein VL, Ayuk FA, Holderried TAW, et al. Estimating the Impact on Survival of Not Receiving CAR T Therapy Despite Being Eligible in Relapsed or Refractory (R/R) Diffuse Large B-Cell Lymphoma (LBCL) Patients in Germany. 2024. [Poster Abstract #5037]. The 66th ASH Annual Meeting and Exposition, San Diego, California.