The Annual Meeting of the American Society of Hematology (ASH) showcases the latest breakthroughs in hematology and presents important research on societal issues about how healthcare is delivered.
In recent years, including 2022, concerns around disparities have been highlighted. In this abstract: Racial/Ethnic, Sex, and Income Disparities in Overall Survival (OS) in Chronic Lymphocytic Leukemia (CLL) Patients in the Era of Targeted Therapy: Surveillance, Epidemiology, and End Results (SEER) Registry Analysis (2009-2019), we learned we still have work to do to address disparities.
The Bottom Line:
Non-Hispanic-Blacks, males, and those with lower incomes with CLL had higher death rates than Non-Hispanic-Whites, Hispanics, females, and those with higher incomes.
Who Performed the Research and Where Was it Presented:
This research was presented at ASH 2022 and used SEER data. SEER refers to the federal government’s Surveillance, Epidemiology, and End Results, SEER for short. This information is free online at The Surveillance, Epidemiology, and End Results (SEER) Program. Search around for CLL statistics.
Prior research at the Veteran’s Administration (VA) and another study presented at ASCO 2022: Influence of Racial and Ethnic Identity on Overall Survival in Patients With Chronic Lymphocytic Leukemia has reported on disparities in chronic lymphocytic leukemia care based on race and socioeconomic status, but there was a need to update the data in the era of improved outcomes with the use of targeted therapies such as ibrutinib, acalabrutinib, zanubrutinib, and venetoclax.
The authors analyzed the SEER registry for patients diagnosed with CLL between 2009-2019 to examine the association between CLL mortality and race/ethnicity, sex, and socioeconomic status.
SEER data were collected for patients older than 15 with a pathologically confirmed CLL (ICD-0-3) diagnosis between 2009 and 2019. Variables extracted included: age at diagnosis, sex, ethnicity/race (non-Hispanic white [NHW], non-Hispanic black [NHB], Hispanic), annual household income (≥$75,000, $65,000-$74,999, $55,000-$64,999, <$55,000) and rural/urban area of residence.
- A total of 32,701 patients (61% males, 39% females) met the eligibility criteria for the study.
- Overall survival (OS) was significantly better among women (HR=0.74; 95%CI=0.68-0.81)
- Overall survival (OS) was considerably better in NHWs (HR=0.57; 95%CI=0.49-0.66) and Hispanics (HR=0.65; 95%CI=0.52-0.82) when compared to NHBs.
- OS was significantly lower in patients with an annual income of $55,000-$64,999 (HR=1.25; 95%CI=1.10-1.41) and <$55,000 (HR=1.28; 95%CI=1.10-1.49) compared to income >$75,000. However, $65,000-$74,999 income did not show OS differences compared to income ≥$75,000.
- Urban/rural residence was not associated with differences in OS.
We learned that men, NHB, and those with incomes <$65,000 a year are more likely to die of their CLL and that, surprisingly, rural versus urban location does not lead to poorer outcomes, but we don’t know why any of these differences or lack thereof exist.
We can speculate. Is disease biology or lifestyle different in men compared to women and in NHB compared to NHW and Hispanics? Do they present later with more advanced disease? Is their treatment delayed or different?
We urge our NHB readers to consider the MAYO clinic trial Germline and Somatic Genomic Studies in CLL Minorities (scroll down) open now that is trying to answer some of these questions by looking at the biology of CLL cells in different ethnicities.
At the same ASH meeting, we got a hint of one possible factor, the biomarker of telomere length from this study Chronic Lymphocytic Leukemia in African Ancestry Population Is Characterized by Increased Telomere Erosion.
Regardless of how much genetics and environment contribute to poorer outcomes, we must work together to ensure that all CLL / SLL patients get their best care.
Links and Resources:
Watch my review of this abstract:
To read the actual ASH abstract, click on Racial/Ethnic, Sex, and Income Disparities in Overall Survival (OS) in Chronic Lymphocytic Leukemia (CLL) Patients in the Era of Targeted Therapy: Surveillance, Epidemiology, and End Results (SEER) Registry Analysis (2009-2019).
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.