Accessibility and Inclusivity of Chimeric Antigen Receptor T-cell Immunotherapy in Treating Hematological Malignancies

Abstract

Targeting the molecule cluster of differentiation 19 (CD19), chimeric antigen receptor (CAR)-T-cell therapy is an artificial immune cell therapy now used in clinical practice for hematological malignancies. Studies on CAR-T-cell therapy have shown that it is highly effective, with high objective response rates (ORRs) and, in certain cases, promising progression-free survival (PFS). Notwithstanding, impediments can arise because of the emergence of resistance mechanisms, including the loss of CD19 antigen and immune suppression caused by the tumor microenvironment. Immune checkpoint inhibitors, allogeneic CAR-T cell treatment, and sequential CAR-T cell therapy are methods employed to overcome these barriers. Research on the use of CAR-T-cell therapy for T-cell malignancies and other disorders is still underway, despite the treatment's impressive results in treating B-cell malignancies. The therapy's high purchase cost and the lack of conclusive clinical proof make cost-effectiveness difficult to achieve. The scarcity of specialist facilities providing CAR-T therapy further impedes access, necessitating patients to surmount logistical and financial obstacles. To increase accessibility and affordability and to ascertain its long-term cost-effectiveness, more thorough investigations are required. CAR T-cell immunotherapy has a bright future ahead of it but to be used more widely and fairly, several important issues must be resolved. This review paper aims to assess critically the current accessibility and inclusivity of CAR T cell immunotherapy, identifying barriers and opportunities to enhance its application in the treatment of hematological malignancies.