Did I receive CAR-T treatment because of white privilege?

Check this out from JAMA:

Fair Allocation of Scarce CAR T-Cell Therapies for Relapsed/Refractory Multiple Myeloma

I imagine this is of interest to practically nobody, but it's right in my strike zone. So let's see what it says:

A 2023 study of centers offering CAR T-cell therapy for multiple myeloma found that for every allocated slot per month per center, there were 20 patients on the waitlist; patients were waiting a median of 6 months prior to leukapheresis.

That sounds about right. I waited even longer than that. In most places, the earlier you get on the waitlist the better, which the authors think is unfair:

This “first come, first served” allocation system is problematic because the US health care system prioritizes wealthy and well-connected patients for advanced treatments such as CAR T-cell therapy. In the clinical trial setting, there have been socioeconomic and racial disparities in enrollment for CAR T-cell therapy in multiple myeloma, with low representation of Black individuals.

Hey, that describes me! White, affluent, and well insured. The authors believe that the highest priority should instead be given to patients with the earliest date on which they qualified for CAR-T, which is usually only after four previous complete chemotherapy regimens. So even if you signed up later than me, for example, you'd have priority if you had an older case of multiple myeloma and had finished up your fourth round of chemo before I did.

Interestingly, this was something I remember thinking about while I was waiting to get to the top of the waitlist. On the one hand, obviously I thought that someone with a more serious disease profile—i.e., someone who might die if they had to wait very long—should be pushed ahead of me on the waitlist. On the other hand, if you do this too aggressively it means that most people won't receive the treatment until they're so sick that they have little chance of fully recovering. Shouldn't we also include some of the relatively healthier patients who are likely to benefit the most from treatment? The authors also point out that the very sickest patients have a high risk of dying just in the few weeks that it takes to prepare the CAR-T cells. When that happens, the CAR-T slot has been wasted since every cell preparation is unique to the patient and can't be given to someone else.

So what to do? In my case, I believe that City of Hope and Kaiser Permanente have a committee that reviews cases and creates the waitlist—which is based partly on when you signed up but partly on other factors that the committee weighs. That's probably why it took a year before I finally received treatment. I was too damn healthy.