ASCO 2023: Racial Disparities in CLL Care

Dr. Adam Kittai a CLL specialist and assistant professor with the The Ohio State University Comprehensive Cancer Center shared with us at the recent ASCO 2023 conference research his team found about racial disparities (unfair medical treatment differences) in chronic lymphocytic leukemia care for Black patients. Dr. Kittai also discussed potential solutions to help bring equality to patient care. 

Watch his full video below: 

CLL Racial Disparities in Modern Therapies

Using the Flatiron Health database which includes data from both academic and private practices, Dr. Kittai and his team found that Black CLL patients fared worse than White CLL patients despite modern small molecule treatments such as ibrutinib, acalabrutinib, zanubrutinib, and venetoclax.

This is disheartening as small molecule inhibitors represent a significant advancement in CLL treatment moving away from chemo treatments. While the newer therapies have benefited many patients, they seem to be less effective in improving survival rates for Black patients. 

Areas of the study

The study evaluated different areas for Black and White CLL patients who received small molecule inhibitors.

The areas included:  

• Treatment types: Despite receiving the same types of small molecule inhibitors, Black CLL patients had worse survival rates than White CLL patients 

• Age: Younger Black CLL patients between 30-50 years old experienced worse overall survival compared to White CLL patients in the same age range

• Treatment timeline: Black CLL patients were visiting a CLL specialist with more advanced stages of the disease than White CLL patients. This resulted in the patients needing to be treated shortly after diagnosis. Further research needs to be done to identify if the delay in diagnosis is because of less access to healthcare providers or for other reasons 

• Genetic mutational status: Black patients had higher rates of unmutated IGHV status and deletion 11q, both of which are associated with poorer prognostic outcomes 

• Lines of treatment: Black CLL patients received more small molecule inhibitor lines of treatment than White CLL patients. While the reasons for this difference require further investigation, it raises questions about the impact of treatment sequencing on outcomes. Understanding how different treatment approaches affect patients could be crucial in narrowing the survival gap 

Supporting Black CLL Patients with Further Research

To improve CLL care for Black patients, further research needs to be done to review solutions to the above issues and find the exact causes behind the disparities. Further research is needed to analyze societal issues, systemic racism, and potential access-to-care obstacles that might contribute to these differences.

Dr. Kittai asks CLL specialists to consider what can be done to help improve the healthcare of Black CLL patients. Supportive measures could include monitoring this patient group to ensure there are fewer side effects, ensuring each patient has access to a primary care doctor, and conducting more clinical trials to identify effective treatment options for the Black CLL patient community.