Survival Disparity Persists Between Black and White Patients With CLL

Black patients with chronic lymphocytic leukemia (CLL) have a survival disadvantage compared with White patients, according to a study published in the American Journal of Hematology.

“There remains a significant disparity in survival rates between Black and White patients with CLL, which was not seen when other minority groups were compared to White patients,” wrote corresponding author Victoria A. Vardell, MD, and coauthors from the University of Utah Huntsman Cancer Institute in Salt Lake City.

In the largest study of its kind, researchers used the National Cancer Database to identify 97,804 patients diagnosed with CLL between 2004 and 2018 to analyze treatment and survival differences among racial and ethnic groups. Of the patients, 90.7% identified as White, 7.6% as Black, 2.6% as Hispanic, and 0.6% as Asian.

Black patients had a median overall survival of 7.0 years compared with 9.1 years for White patients, according to the study. Rates of 5-year survival were 61% for Black patients and 69% for White patients, and rates of 10-year survival were 36% for Black patients and 46% for White patients.

When researchers matched Black and White patients for age, comorbidities, and socioeconomic factors, White patients retained a significant survival benefit: a median overall survival of 8.5 years, compared with 6.6 years for Black patients.

“This indicates a likely multifactorial process contributing to the survival disadvantage seen for Black CLL patients, which may include factors impacting access to novel treatments and clinical trials, more advanced disease at diagnosis, as well as genetic variability in disease,” researchers wrote.

Analysis of survival disparities over time hinted at improvement, however. Hazard ratios for death for Black patients compared with White patients were 1.64 for patients diagnosed between 2004 and 2006 but improved to 1.37 for patients diagnosed between 2013 and 2015. Nevertheless, between 2016 and 2018 — the most recent diagnostic period assessed — the hazard ratio was again 1.64, according to the study.

Reference:
Vardell VA, Ermann DA, Fitzgerald LA, Shah HR, Hu B, Stephens DM. Influence of racial and ethnic identity on overall survival in patients with chronic lymphocytic leukemia. Am J Hematol. Published online April 20, 2023. doi:10.1002/ajh.26937