Authored by Ann Liu, PhD
Medically Reviewed by Brian Koffman, MDCM )retired), MSEd
The Bottom Line:
Black and Hispanic patients with CLL were less likely than White patients to be prescribed guideline-recommended novel therapies. This study was associated with social factors such as residential segregation, lack of internet access, lack of health insurance, and not owning a vehicle.
Who Performed the Research and Where Was it Presented:
Dr. Joanna Rhodes from Rutgers Cancer Institute and colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting in 2025.
Background:
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are known to occur predominantly in older White men, which makes it harder to study in non-White patients. Previous research has shown that Black patients with CLL / SLL have poorer survival outcomes than White patients. However, other studies have shown that when patients have access to treatment with modern, standard-of-care targeted therapies, those differences disappear. This study looked at what factors influence whether patients were prescribed first-line treatment with standard-of-care novel therapies.
Methods and Participants:
This study was a retrospective using electronic health record data from the Flatiron Health Research Database. The study included adults with CLL who started first-line treatment for CLL between 2019 and 2024. Researchers looked at social factors that might affect whether patients received National Comprehensive Cancer Network (NCCN) guideline-preferred novel therapies, such as acalabrutinib, zanubrutinib, and venetoclax-based regimens, which are now preferred over ibrutinib and chemoimmunotherapy as first-line therapies.
Results:
- A total of 4452 patients were included in the study, of which 83% were White, 8% were Black, 5% were Hispanic, and 4% were other races.
- Overall, 37% of patients received an NCCN-preferred novel therapy.
- Compared with White patients, Hispanic patients were more likely to receive chemoimmunotherapy than preferred novel therapies.
- Both Black and Hispanic patients were more likely to receive ibrutinib rather than preferred novel therapies.
- Factors associated with being less likely to receive preferred novel therapies included:
- Living in a predominantly Black or Hispanic neighborhood
- Low socioeconomic status
- Lack of internet access
- Not owning a vehicle
- Not having health insurance coverage
Conclusions:
Black and Hispanic patients with CLL were less likely than White patients to be prescribed guideline-recommended novel therapies, and this finding was associated with social factors such as residential segregation, lack of internet access, lack of health insurance, and not owning a vehicle. While there has been an emphasis on educating healthcare providers to increase awareness about novel therapies for CLL, this study shows that there are also structural barriers that affect the likelihood of a patient receiving these guideline-recommended therapies. Access to care continues to be a major challenge that will likely require intervention at the governmental level.
Links and Resources:
Watch the interview on the abstract here:
You can read the actual ASH abstract here: Mediators of racial and ethnic inequities in access to front-line therapies for chronic lymphocytic leukemia in the United States: A real-world evidence study.
CLL Society has reported on similar research on disparities in CLL care in Uptake of CLL Targeted Therapy by Race and Ethnicity.
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