Medically Reviewed by Dr. Brian Koffman
The Bottom Line:
In the era after the introduction of BTK inhibitors, survival outcomes for CLL patients were not different by race or ethnicity. These data suggest targeted therapies may be helping reduce racial disparities in the treatment of CLL and in patient outcomes.
Who Performed the Research and Where Was it Presented:
Dr. Debora Bruno from the University Hospitals Cleveland Medical Center and colleagues published their findings in Acta Haematologica in May 2024.
Background:
While chronic lymphocytic leukemia (CLL) / small lymphocytic lymphoma (SLL) is most commonly diagnosed in White patients in the United States, Black patients have historically had worse outcomes and significantly shorter overall survival. At the time of diagnosis, Black patients tend to present with characteristics that suggest more aggressive disease compared with White patients. A previous study found that Black patients were twice as likely to die from CLL in the first five years from diagnosis compared with their White counterparts. These earlier studies on racial disparities in CLL patient outcomes were conducted before the introduction of Bruton tyrosine kinase inhibitors (BTKi), such as ibrutinib, which revolutionized the treatment of CLL. In this paper, researchers looked at racial disparities in CLL patient outcomes in the post-BTKi era.
Methods and Participants:
This study used electronic health records from a national database and included patients diagnosed with CLL between 2013 and 2022 who received treatment for their disease. Patient characteristics, treatment patterns, and outcomes were compared by race and ethnicity.
Results:
- A total of 6,372 patients were included in the study, of which 72% were White, 9% were Black, and 4% were Hispanic or Latino.
- Patients who were Black were younger, more likely to be female, of lower socioeconomic status, and more likely to have unmutated IGHV and deletion 11q than White patients.
- Patients who were Black had a shorter time from diagnosis to initiation of first therapy.
- Patients who were Hispanic or Latino were also younger and had lower socioeconomic status compared to White patients, but there were no differences in sex or molecular subtypes.
- Patients who were Black, Hispanic, or Latino were less likely to receive care in an academic practice setting and more likely to be treated in centers with lower total patient volume.
- Overall, Black patients were more likely to be treated with covalent BTKi (67%) than White patients (56%).
- There were no significant differences in time to the subsequent treatment or death by race or ethnicity.
- There were no significant differences in overall survival by race or ethnicity.
Conclusions:
In the era after the introduction of BTKi, survival outcomes for CLL patients were not different by race or ethnicity. This suggests that the introduction of covalent BTKi therapy has narrowed the survival gap that was previously seen between Black and White patients with CLL. In this study, Black patients had a shorter time to treatment initiation and were more likely to be treated with BTKi compared with White patients. While this study cannot establish causation, it does provide encouraging data that suggest targeted therapies may be helping reduce racial disparities in the treatment of CLL and in patient outcomes.
Links and Resources:
The full article by Dr. Bruno and colleagues can be found here: Racial and Ethnic Characteristics and Outcomes of Patients Diagnosed with CLL / SLL in the USA
Take care of yourself first.
Ann Liu, PhD
