EHA 2025 | The uptake of targeted agents by race/ethnicity in patients receiving first-line treatment for CLL

So in this abstract, we expanded upon previous work where we found that black patients had worse overall survival than white patients with CLL in the United States looking at SEER data. So when we did this original work, the big question was why are we seeing this disparity? And so we thought more closely about this disparity and reasons why this might occur, and so we thought maybe access was an issue. So the next database we looked at was the Flatiron Health database, which alleviates this access issue because patients who are on this database have access to an oncologist. And when we looked at the Flatiron Health database, we found that in fact black patients had equal survival to white patients, which is also a very interesting finding, especially given the disparity that we observed in the United States. So then we did further work and we found that diseases that are more amenable to treatment, meaning there are more treatments available to them, have wider disparity than diseases that don’t have treatments available to them. So what this means is that the patients who are minorities are less likely to get our preferred regimens, right? So therefore, they’re less likely to live as long with these diseases that are amenable to treatment because they’re not getting access to the most modern-day therapies. So we looked at the Flatiron Health data again, and this is the abstract being presented here. And what we found was that Hispanic patients are less likely to get preferred agents than patients who are black or white. Preferred agents are agents listed underneath the NCCN guidelines, underneath preferred, and are changed frequently based off of the most current data. So what we’re seeing here is that patients who had access to an oncologist in the Flatiron data who were Hispanic were less likely to get the most modern-day therapies, which could explain the disparity we observed in the amenable treatments on the SEER data. Furthermore, when we looked at the database, we found that when the treatments were updated on the NCCN guidelines, community and academic practices were more likely to use the up-to-date therapies, which suggests the importance of the NCCN guidelines, keeping our doctors informed about what the most important updates in CLL and other hematologic malignancies are. Lastly, we saw some interesting key differences in patient demographics. For one, black and Hispanic patients were less likely to be treated at academic centers than white patients. And black patients had higher rates of the IGHV unmutated status compared to white patients as well. So I think that with each additional study that we do, looking at disparities in patients with CLL, it answers a niche part of the question of why we are observing this disparity in the United States. And I think that the most important barrier that we’re witnessing is a barrier to access. And we need to alleviate that access in order for all of our patients to get the most preferred agents and are seen at an oncology clinic. And if we are able to achieve these things, I’m hopeful that the disparity that we observe between black and white patients in the United States as well as other minorities is a little alleviated as the barrier to access becomes less of an issue. And I think that ultimately this has to come top down from government intervention. But as academic and private practice doctors, we can also think about novel ways that we can bring therapy to patients, open up clinics where they live, make sure that we are thinking about all of our patients equally when they walk into the door, and offer them all of the modern-day therapies that we have available at our disposal. And with those small interventions, we may be able to make a big impact nationwide.

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