Abstract
Analysis of racial disparities accounting for treatment received in chronic lymphocytic leukemia: A real-world cohort analysis.
Author
person
Adam Kittai
Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
info_outline
Adam Kittai, Ying Huang, Seema Ali Bhat, Abi Clark, Michael R. Grever, Melyssa Roberts, Kerry Anne Rogers, Anna Teschemaker, Maria Munoz-Sagastibelza, Jennifer Ann Woyach, Jacqueline Claudia Barrientos
Full text
Authors
person
Adam Kittai
Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
info_outline
Adam Kittai, Ying Huang, Seema Ali Bhat, Abi Clark, Michael R. Grever, Melyssa Roberts, Kerry Anne Rogers, Anna Teschemaker, Maria Munoz-Sagastibelza, Jennifer Ann Woyach, Jacqueline Claudia Barrientos
Organizations
Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, US Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, Global Medical Affairs, AstraZeneca Pharmaceuticals, Gaithersburg, MD, Mount Sinai Comprehensive Cancer Center, Miami Beach, FL
Abstract Disclosures
Research Funding
Pharmaceutical/Biotech Company
AstraZeneca
Background:
Recent population-based studies have shown that Black patients (pts) with CLL have worse overall survival (OS) than White pts with CLL. These studies could not account for the use of modern therapies, CLL prognostic variables, or comorbidity and thus the root cause of this disparity remains unclear. Here, we use the Flatiron Health Database (FHD) to study this disparity, while accounting for disease-specific variables and treatment (tx) received.
Methods:
Retrospective analysis of pts with CLL in the FHD treated between 2002 to 2022 was performed. Pt characteristics such as age at diagnosis (dx), year (yr) of dx, months (mos) from dx to first tx, race, sex, IGHV status, ECOG performance status (PS), and use of small molecule inhibitors at any time (including BTK inhibitors, venetoclax, PI3K inhibitors, and lenalidomide) were collected and analyzed. OS was measured from tx start. Multivariable cox regression (MVA) was used to determine adjusted odds of survival.
Results:
13646 pts with CLL were identified. Mean age at dx was 65.3 yrs, and mean time from dx to tx was 32.3 mos. 81.2%, 8.4%, and 10.4% of pts were White, Black, or other race, respectively, and 63.2% of pts were male. 61.4% of pts were IGHV unmutated, and 89.1% of pts had a ECOG PS 0/1. 58.7% of pts were treated with a small molecule inhibitor at any point during their tx. After a median follow-up of 5.3 yrs, the median OS was 10.5 yrs (95% CI: 10.2-10.8). Black pts were younger at dx (63.1 vs 65.4), had shorter time to first tx (23.6 mo vs 34 mo), were more likely to be IGHV unmutated than White pts (83% vs 60.1%), and had more small molecule inhibitor use (69% vs 58.5%). These differences were all statistically significant (p <0.01). 90.8% and 89.1% of Black and White pts had an ECOG PS of 0/1, respectively. Median OS for Black pts was 10 yrs (95% CI: 9.1-11.1) vs 10.5 yrs (95% CI: 10.2-10.8) for White pts. On MVA, Black pts had higher risk of death than White pts of the same age despite increased use of small molecule inhibitor (Table). However, the interaction between age and race was also significant, indicating a decreasing disparity between Black and White race as pts aged. Time to first tx, IGHV unmutated status, and ECOG PS were also independently associated with worse OS.
Conclusions:
Black race especially at younger age was independently associated with worse OS despite the use of small molecule inhibitors, IGHV status, and ECOG PS.
MVA of pt characteristics on OS.
N=10152*
HR (95% CI)
P-value
Age, 5-yr older
White
Black
1.50 (1.46-1.54)
1.32 (1.24-1.41)
<.01
Mos from dx to tx start, 6 more mos
1.03 (1.03-1.04)
<.01
Race, Black vs White at age
30
50
70
2.93 (1.74-4.93)
1.76 (1.36-2.28)
1.06 (0.93-1.20)
<.01
IGHV vs Mutated
Unmutated
missing
1.29 (1.13-1.47)
1.41 (1.26-1.58)
<.01
ECOG PS vs 0-1
2-4
missing
2.08 (1.85-2.33)
0.89 (0.83-0.96)
<.01
Use small molecule inhibitor vs No
0.80 (0.75-0.86)
<.01
*Controlled for gender and region.
3 organizations
4 drugs
4 targets
Organization
Medical Affairs, AstraZeneca PharmaceuticalsOrganization
Mount Sinai Comprehensive Cancer CenterDrug
BTK inhibitorsDrug
venetoclaxDrug
PI3K inhibitorsDrug
lenalidomideTarget
BTKTarget
lenalidomideTarget
BCL-2Target
PI3Kα