What’s Keeping Patients from the Best First-Line CLL Treatments?

Are all chronic lymphocytic leukemia (CLL) patients receiving the most up-to-date first-line treatments?

Learn how real-world treatment patterns for CLL have changed over time, and how factors like race and ethnicity, treatment center type, and other patient characteristics have influenced the use of recommended therapies. 

How treatment guidelines for CLL have changed over time

Specialist guidelines help doctors choose the best treatment options for people with CLL. Over the past decade, the recommendations have shifted. Older treatments like chemoimmunotherapy and the first-generation BTK inhibitor ibrutinib were once widely used.

More recently, the recommendations have moved to newer options like second-generation BTK inhibitors and venetoclax with obinutuzumab as preferred first-line therapies. These newer treatments are often more effective with fewer side effects than chemoimmunotherapy or ibrutinib.

Understanding these updates can help people with CLL know what treatments may be best for them based on the latest medical standards.

What this real-world study looked at

At the European Hematology Association (EHA) conference, Dr. Adam Kittai from the Icahn School of Medicine at Mount Sinai presented findings on a study that used data from over 7,500 people with CLL who started first-line treatment between 2016 and mid-2024. 

The goal was to see whether patients were receiving treatments that matched current guidelines when they started care. Researchers also looked at differences based on race and ethnicity (Black, Hispanic, White) and whether patients were treated in community practices or academic centers.

Analyzing these things can help identify gaps in access to the best available therapies.

Differences in treatment by race and ethnicity

The study found that Hispanic individuals with CLL were less likely to receive recommended first-line treatments compared to White individuals. For Black patients, the percentage receiving preferred therapies was similar to that of White patients overall. 

This is important because unequal access to the most effective therapies can impact health outcomes and quality of life. Barriers to accessing treatment may have included examples like limited healthcare coverage, fewer local specialists, language differences, or mistrust of doctors. Knowing which minority groups were most affected can help focus support where it’s needed most. 

How treatment center type affected preferred therapy use

Whether someone was treated at a community practice or an academic center also made a difference. Early on (2016–2018), only 44% of community practices were using targeted therapies compared to 55% of academic centers.

After new therapies like zanubrutinib were approved, their use increased in both settings. By 2023–2024, about 71% of patients in community practices and 74% in academic centers were receiving targeted therapies.

This highlights that where a person receives care may influence how quickly they can access newer, recommended treatments.

Patient characteristics can influence treatment choice

Only 19% of people in the study were under 65, physically fit, and free of high-risk CLL genetic changes like del(17p) or TP53 mutations. Those who received the venetoclax and obinutuzumab combination were more likely to meet these criteria than the overall group.

These details matter because certain treatments may be more suitable based on a person’s health status and CLL genetics. Click the button below to learn more about things to consider when selecting a CLL treatment. 

Considerations for CLL Treatment Selection

CLL treatment guideline changes drive therapy patterns

Each time CLL treatment guidelines were updated, therapy patterns shifted. In response to these changes, more patients received preferred therapies. However, when second-generation BTK inhibitors were recommended, the number of patients receiving these newer treatments initially dropped.

This suggests that changes in guidelines take time to be adopted widely, especially in community practices.

Why this study matters for people with CLL

This research shows that not everyone with CLL is receiving the most up-to-date treatments. Gaps based on race and ethnicity, where someone receives care, and health factors may limit access to newer, more effective options.

People living with CLL can use this information to ask their doctor questions to ensure their treatment plan aligns with current recommendations.

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Real-world studies like this are made possible through the experiences shared by people living with CLL. By joining HealthTree Cure Hub®, you can take simple, anonymous surveys that help drive research and improve care for the community. Your input makes a real difference! Click the buttons below to get started or see the current impact of this research.

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Source: 

• Evaluating uptake of targeted agents by race/ethnicity in patients receiving first-line treatment for chronic lymphocytic leukemia