Does Race Have an Impact on CLL Care? What the Latest Data? | Adam Kittai, MD #EHA2025

Hi, my name is Adam Kite. I'm an associate professor at the Icahn School of Medicine at Mount Sinai. And here we are at IHA in Milan, Italy. I'm excited that I'm presenting an abstract looking at racial disparities in patients with CLL. We have done some prior work that showed that Black patients have shorter overall survival compared to white patients when we looked at SEER data, which is a national database that looks at outcomes of patients across the United States. And we were trying to figure out why we saw the disparity. So then we used something called the Flatiron database, which is a database of patients in the United States treated in oncology clinics. And what we found in that particular database was that there was no disparity observed. And in fact, Black patients were just as likely as white patients to get modern therapies for patients with CLL. What this suggested was that maybe there was an access issue where patients who had access to an oncologist was able to get the appropriate care that they deserved. So then knowing this data, we did further analyses of the Flatiron health database. And this time we took a look to see how often patients were getting treated with the most modern therapies. So there are these guidelines called the NCCN guidelines, which are updated periodically based off the most updated data for CLL and all other malignancies. And we wanted to see as these guidelines were updated, were physicians more likely to treat patients of varying races with the most up-to-date preferred regimens? And what we found looking at the data was that in fact, Black and white patients were being treated with the most up-to-date regimens across time. But Hispanic patients were less likely to get preferred regimens as they were adjusted on the NCCN guidelines. This suggests that we aren't treating all our patients equally, and we need to pay close attention to make sure that all of our patients are getting the preferred regimens, which are standard of care per our NCCN guidelines. A couple of other things that we found in this particular abstract was that minority patients were less likely to be treated at academic centers, that Black patients were more likely to have a high-risk feature for CLL called IGHV unmutated status. And lastly, as our data was updated on these guidelines, it led to upticks in the community and academic practice in using these most up-to-date medications, suggesting that it's important to update these guidelines appropriately as fast as we can when we have new data available to us showing improvements in survival for our patients, because this is directly reflected in what's being prescribed in the clinic. Lastly, more work is to be done to make sure that all of our patients are being treated equitably, and that all of our modern-day therapies are being used ubiquitously across races. We need to do further work to figure out how to alleviate the barriers and access issue, to alleviate the disparities observed on the SEER data mentioned earlier. And this is likely going to be needed to be done top-down through governmental intervention, but academic doctors and private practice doctors can be mindful of the patients they see in their clinic to make sure that we are treating everybody equally and making sure we're offering our most modern therapies to all patients.