The success of CAR T-cell therapy for refractory B-cell lymphomas is quite the medical marvel. Unfortunately, beyond its 6-week minimum “vein-to-vein” time, there remains a national shortage in the manufacturing of its required vector. This viewpoint highlights the disappointing ways such scarcity leads to the rich and connected preferentially receiving such a scarce commodity. For example, most workflows start the clock for CAR T-cell receipt from time of initial consultation at a center that provides it. There are clear hurdles to getting timely appointments at such centers, particularly for the medically illiterate, leading to the suggestion here that patients be prioritized based on the time at which they become clinically eligible for CAR T-cells regardless of consultation date. It also questions prioritizing patients with the highest disease burden and aggressiveness given death during “vein-to-vein” time is the most wasteful approach of all. Finally, as with all burdensome oncology treatments, centers should proactively work to provide resources to overcome transportation barriers for the most economically vulnerable. | Derman, JAMA 2023
