The Glass Wall: Gendered Authorship Disparities in in CD 19 and BCMA CAR-T Clinical Trials for Lymphoma and Myeloma

Abstract

Introduction: Existing literature suggests that women are significantly underrepresented in the field of hematology-oncology. Data from 2021 suggests that women make up 35.6% of hematologists, and thus the disparity continues in clinical trial research authorship. Minorities including women receive fewer awards, deliver fewer board review lectures, and hold fewer professorships, and leadership positions in clinical departments and professional organizations. To further investigate this issue, we conducted a study to assess the gender gap in authorship across 13 pivotal clinical trials that led to the approval of CD19 and BCMA Chimeric antigen receptor T cell (CAR-T) therapies. Methods: We included the 13 pivotal trials that led to the approval of CART for Acute Lymphoblastic leukemia (ALL), lymphoma and myeloma , published between 2017-2022. These included the trials: ELIANA, ZUMA-1, JULIET, ZUMA-2, KarMMa, TRANSCEND, ZUMA-5, CARTITUDE-1, ZUMA-7, ZUMA-3, TRANSFORM, PILOT, and ELARA. We examined the overall number of female authors, the number of lead female authors as defined as first, second, or last author, and the ratio of all authors to female authors. 367 total authors were included in the analysis, with several authors being included more than once for their work on separate studies. Results: Table 1 summarizes the results. Of the 367 authors assessed, 109 were female, correlating to 28.9% female authorship. The only study with female authorship >50% was ELIANA, a 2017 pediatric study, while all others had >50% male authorship. 7 (54%) of the 13 studies had females as lead authors; of note, 6 out of 7 of these studies were published after 2021. Conclusion: Gender inequities in research authorship are pervasive in many areas of medicine, including the field of immune effector cell therapy. Publications in the field broadly are overwhelmingly male dominated, possibly reflective of lower female representation in transplant and cellular therapy. Despite this, we observed improved gender equality in authorship in more recent publications since 2021, and in certain research areas such as pediatric hematology-oncology. Recognizing these seemingly invisible barriers is the first step in bringing gender equity to the field of hematopoietic stem cell transplant and cellular therapy, with gender serving as one of many domains in which underrepresented groups' ability to scale the glass wall must be supported. Table 1.