What follows is our patient-friendly summary of this research.
The Bottom Line:
Being American Indian/Alaska Native and Black were independent prognostic variables for having shorter overall survival (OS). At the same time, higher socioeconomic status (SES) was found to be significantly and independently associated with living longer.
By whom and where were the research and presentation done:
Dr. Adam Kittai and colleagues at the Ohio State University Comprehensive Cancer Center, Columbus, Ohio, presented the results at the American Society of Clinical Oncology (ASCO) Annual Meeting in 2022.
Background:
Therapy for chronic lymphocytic leukemia (CLL) has improved over the last two decades with novel oral targeted agents, improved immunotherapies, and better testing. However, it is not clear if all have benefited equally.
The team at Ohio State University Comprehensive Cancer Center used Surveillance, Epidemiology, and End Results (SEER) data to determine how race and socioeconomic status (SES) affect survival for those with CLL. SEER is a free resource of the NIH, specifically the National Cancer Institute (NCI), and is “an authoritative source for cancer statistics in the United States.”
Method and Participants:
CLL cases reported to 18 SEER Program registries from 2006 – 2018 were studied. Data were characterized as to:
- age at diagnosis
- sex
- year of diagnosis
- race
- socioeconomic status (SES)
Statistical analysis was done using multivariable cox regression (MVA) to determine adjusted odds of survival.
Results:
- 6,605 cases from 2009 – 2018
- The median age was 70 years,
- 60% were male
- 89.9% were white, 7.3% Black, 2.4% Asian/Pacific Islander, and 0.3% American Indian/Alaska Native.
- After a median follow-up of 47 months, the median 3, 5, and 10-year overall survival (OS) was 79.5%, 69.5%, and 48.8%, respectively.
- Multivariable cox regression showed Black race (HR 1.5) as the strongest independent prognostic variable for worse overall survival controlling for the year of diagnosis, suggesting race was a significant factor in overall survival in the era of modern therapies.
- Higher socioeconomic status was a significant independent prognostic variable for improved overall survival.
- In this analysis, race remained an independent variable for worse overall survival after controlling for socioeconomic status.
Conclusions:
Black race and low socioeconomic status (SES) are prognostic of shorter overall survival in CLL. However, further research is needed to determine whether this is due to access to therapy, quality of care, social determinants of health, or disease biology.
CLL Society is working with Mayo Clinic on a trial as to why this might be. Is it something about the disease itself in blacks, or is the answer more environmental, or is it about treatment choices? We simply don’t know, but if you are from an underrepresented minority, please consider helping us get the answers by enrolling in the free trial: The Genetics of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL / SLL) in African Americans and Other Minorities.
Links and resources:
The ASCO 2022 abstract that gives more detailed statistics can be found by clicking here:
A similar abstract was presented at the same meeting with similarly discouraging findings: ASCO 2022: Influence of Racial And Ethnic Identity on Overall Survival in Patients With Chronic Lymphocytic Leukemia, which also concluded that “Black patients have significantly shorter overall survival compared to White patients, which is sustained when adjusted for the higher prevalence of comorbidities in the Black CLL population. Unfortunately, the survival gap between White and Black patients has not improved since 2004, highlighting the need for targeted research to improve survival in Black patients with CLL”.
CLL Society to committed to increasing awareness of these persistent disparities and searching for ways to improve outcomes for all.
Stay strong. We are all in this together.
Brian
Brian Koffman MDCM (retired) MS Ed (he, him, his)
Co-Founder, Executive VP, and Chief Medical Officer, CLL Society, Inc.
