Introduction:
Since the introduction of Novel agents (NA) in 2013, the treatment paradigm for CLL has changed significantly with the increased use of novel agents for both first-line (1L) and refractory chronic lymphocytic leukemia (CLL).
Despite improvement in survival outcomes with CLL, Black patients with CLL have demonstrated inferior overall survival compared to White patients. In addition, studies have shown a difference in disease biology between Black and White patients.
However, both differences in disease biology and access to medical care and treatment may have contributed to racial disparities in outcomes.
The purpose of this study presented at the American Society of Hematology Annual Meeting and Exposition in Dec. 2021, more commonly called ASH 2021, was to assess the uptake of NAs in the Veterans Health Administration (VHA), where access to care is equal for both Black and White patients.
Takeaways:
- It was a retrospective study in the VHA from 2014 to 2017 from chart review.
- During at least part of that time, ibrutinib, idelalisib, and venetoclax were available.
- 565 patients’ charts were reviewed.
- 86% were White, and 14% were Black.
- In 2014, 17% of White but only 4% of Black CLL patients were started on a NA.
- By 2017, the disparity had significantly shrunk, with 33% of White and 31% of Black veterans initiating therapy with a novel agent.
Conclusions:
In this retrospective cohort study, there was a statistically significant difference in the use of NAs between Black and White patients with CLL in the VHA for the study period. However, when NA use was examined by year, the disparity was largest in the early study years, with reduced differences in NA utilization over time.
Understanding how and why this disparity was there and how it was mostly eliminated over three years could be significant in preventing future unequal access to best care based on race.
Here is the actual ASH 2021 abstract that includes some excellent graphics: ASH 2021: Uptake of Novel Agents (NAs) As First-Line Treatments for Black and White Patients with Chronic Lymphocytic Leukemia (CLL) in the Veterans Health Administration (VHA): A Retrospective Cohort Study.
Stay strong. We are all in this together.
Brian Koffman MDCM (retired) MS Ed (he, him, his)
Co-Founder, Executive VP, and Chief Medical Officer, CLL Society, Inc.
