CAR T-cell therapy referral patterns and utilization for relapsed/refractory large B-cell lymphoma in the United States

Chimeric antigen receptor (CAR) T-cell therapy has improved outcomes for patients with relapsed/refractory (R/R) large B‑cell lymphoma (LBCL), yet access in routine clinical practice remains limited. We evaluated referral patterns, durability of clinical benefit, and health care resource utilization (HCRU) among US patients with R/R LBCL. Komodo Health US claims data were retrospectively analyzed (October 2016‒May 2025). Adults with R/R LBCL after ≥2 prior lines of therapy who received CAR T-cell therapy at authorized treatment centers (ATC) were included; patients were stratified by referral and treatment status. Outcomes included referral rates, demographics and subsequent treatment, time‑to‑next treatment or death (TTNT-D), and 12‑month postinfusion HCRU. Among 8959 patients, 20% were referred to an ATC and 15% received CAR T-cell therapy (7% originated at an ATC, 8% referred to an ATC). Referred patients were younger (median age, 61.5 vs 67.3 years; P<0.001) and lived closer to ATCs (median distance 17 vs 24 miles; P<0.001). Among referred patients, baseline demographics were similar between CAR T-cell therapy-treated and nontreated groups. In the second‑line closed‑claims cohort, CAR T-cell therapy recipients had longer TTNT-D compared with the nontreated group (median 28 vs 12 months; P<0.005). Inpatient utilization peaked at 1 month postinfusion (mean 1.54 vs 0.62 visits) before declining to similar rates (0.81 vs 0.59). Most eligible patients with R/R LBCL did not receive CAR T-cell therapy due to referral gaps or alternative treatment selection at ATCs. Strengthening referral pathways and increasing awareness of the benefits of CAR T-cell therapy may enable broader, more equitable access.