Authored by Brian Koffman, MDCM (retired), MSEd
Bottom Line:
Fewer Hispanics received preferred first-line treatment for CLL versus white patients, suggesting access to care contributes to observed racial disparities.
Who Performed the Research and Where Was it Presented:
Dr. Adam Kittai from Mount Sinai, NY, NY also a member of CLL Society’s Medical Advisory Board, led a group researcher presenting: Evaluating uptake of targeted agents by race/ethnicity in patients receiving first-line treatment for chronic lymphocytic leukemia (CLL) presented as an abstract at ASCO (American Society of Clinical Oncology) Annual Meeting; May 30-June 3, 2024 in Chicago.
Background:
Dr. Kittai has previously published real-world data on How CLL Impacts Different Racial and Ethnic Populations that suggested, at least for African American CLL patients, access to care was the critical determinant in outcomes rather than intrinsic biologic differences between races. Other reviews, such as Persistent Racial/Ethnic, Sex, and Income Disparities in Overall Survival in CLL Patients, emphasized the importance of race, income, and other social determinants of health in influencing outcomes in CLL, with poorer overall survival seen in lower-income and black patients.
This research aimed to determine whether all patients are treated equitably in terms of their choice of therapies.
Methods and Population Studied:
This was a retrospective observational study utilizing the Flatiron Health database, which was constructed from an extensive collection of electronic health records. To be included in the study, patients must have had a diagnosis of CLL and received first-line therapy between January 1, 2016, and July 31, 2024. The primary outcome studied was the proportion of patients by race who received a preferred first-line treatment, as defined by NCCN guidelines.
Results:
- A total of 7528 patients were included.
- Compared with White patients (n = 5472), Black patients (n = 640) were younger (median age at first line (1L) treatment was 68 versus 71)
- A higher proportion of Black and Hispanic patients (n = 290) were treated at community practices (86% versus 80% of White patients).
- Of those patients tested, more Black patients had unmutated IGHV than White (77% versus 56%).
- Presence of del17p/TP53 mutation was similar across races and ethnicities.
- The proportion of patients receiving preferred 1L treatment based on the NCCN Guidelines significantly differed by race and ethnicity:
- The proportion of Hispanic patients treated with preferred 1L treatment was significantly lower than in White patients (OR = 0.6)
- Blacks’ treatment was similar to Whites.
Conclusions:
Inequities in patients with CLL receiving preferred 1L therapy suggest excessive use of chemoimmunotherapy or CIT and ibrutinib versus the newer safer BTK inhibitors acalabrutinib and zanubrutinib by race/ethnicity. These differences can contribute to worse outcomes. As Dr. Kittai says, “We need to come up with ways to decrease gaps in access to care.”
Sources:
For more details on community versus academic practice and trends over the years of the study, please refer to the abstract itself: Evaluating the uptake of targeted agents by race/ethnicity in patients receiving first-line treatment for chronic lymphocytic leukemia (CLL).
Uptake of CLL Targeted Therapy by Race and Ethnicity – Dr. Brian Koffman
