Influence of racial and ethnic identity on overall survival in patients with chronic lymphocytic leukemia

Vardell, Victoria A.; Ermann, Daniel A.; Fitzgerald, Lindsey; Shah, Harsh; Hu, Boyu; Stephens, Deborah M.

doi:10.1002/ajh.26937

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…White individuals had a 1.4-fold higher incidence rate than Black individuals. 9 Although Black individuals were associated with a worse prognosis than the other races 10,11 due to the higher rate of comorbidities, 12 extra-nodal primary site involvement and advanced disease at the time of diagnosis, 11 our study emphasizes the need for increased vigilance and surveillance for CLL in both the White and Black populations for their high incidence rate and worse prognosis respectively.…”

Section: N (%)mentioning

confidence: 77%

Mortality trends of chronic lymphocytic leukaemia in the United States with the emergence of targeted therapy

Tan,

Yeo,

Tan

et al. 2023

Br J Haematol

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Chronic lymphocytic leukemia (CLL) accounts for more than one-third of the new cases of leukaemias in the United States. 1 Over the past decades, the treatment landscape for CLL has witnessed significant changes. In the light of the revolutionary progress made in treatment modalities for CLL, we aimed to analyse CLL mortality trends in the past two decades to provide a population-based perspective on the impact of these advancements on patient outcomes and also to identify potential demographic disparities.Death certificate data from the US Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was analysed from 1999 to 2020 to determine the longitudinal trends of CLL among the US population aged ≥35 years. Those aged below 35 years were excluded due to low case counts. We selected CLL (ICD-10 C91.1) as the underlying cause of death. We measured age-adjusted mortality rates (AAMRs) of CLL per 100 000 individuals by standardizing to the year 2000 US census population. We plotted the AAMRs per 100 000 individuals to determine the trends from 1999 to 2020.There were 97 186 deaths attributed to CLL from 1999 to 2020. Table 1 shows the baseline demographics of patients who met the inclusion criteria. Overall, there was a decrease in the AAMR of CLL from 3.23 (95% CI, 3.13-3.32) per 100 000 individuals in 1999 to 2.05 (95% CI, 1.99-2.11) per 100 000 individuals in 2020, with the average annual percent change (AAPC) at −2.09 (95% CI, −2.69, −1.49). The annual percent change (APC) was greater in the recent decade from 2011 to 2020 than the previous decade from 1999 to 2011 (−3.16 [95% CI, −3.83, −2.84] vs. −1.56 [95% CI, −2.01, −1.11]) (Table 2). Males had a higher AAMR of CLL than females (3.78 [95% CI, 3.75-3.81] vs. 1.72 [95% CI, 1.71-1.74] per 100 000 individuals). The highest AAMR was observed among non-Hispanic White males (4.14 [95% CI, 4.10-4.17] per 100 000 individuals), followed by non-Hispanic Black males (3.48 [95% CI,] per 100 000 individuals), non-Hispanic White females (1.88 [95% CI,] per 100 000 individuals) and non-Hispanic Black females (1.61 [95% CI, 1.55-1.67] per 100 000 individuals) (Figure S1a). Those who lived in the Midwest region and the rural region had the highest AAMR respectively (2.93 [95% CI, 2.89-2.97] per 100 000 individuals vs. 2.87 [95% CI, 2.83-2.91] per 100 000 individuals) (Figure S1b).Our study demonstrates that the AAMR of CLL decreased by 2% annually from 1999 to 2020. This aligns with

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Section: N (%)mentioning

confidence: 77%

Mortality trends of chronic lymphocytic leukaemia in the United States with the emergence of targeted therapy

Tan,

Yeo,

Tan

et al. 2023

Br J Haematol

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“…Furthermore, in the COVID-19 era, a high case-fatality rate and a poor response to vaccination were documented with fixed-duration and continuous treatment [104][105][106]. Overall, despite these improvements, the influence of racial and ethnic identity on OS in CLL is still significant, despite an encouraging possible reduction in the survival disparity between Black and White U.S. patients within the last 5 years [107].…”

Section: Discussionmentioning

confidence: 99%

First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era

Urso,

Cavazzini,

Ballardini

et al. 2023

Cancers

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Bruton tyrosine kinase inhibitors (BTKi) and the BCL2 inhibitor venetoclax, with or without the anti-CD20 monoclonal antibody Obinutuzumab, represent the preferred options for the first-line therapy of CLL because they are more effective and may improve quality of life. However, patient inclusion criteria are heterogeneous across trials designed for older patients, and the identification of CLL-specific parameters identifying unfit patients at risk of developing drug-specific adverse events is required to guide treatment choice. Due to inclusion/exclusion criteria in trials, higher discontinuation rates with BTKi were reported in real-world studies, and registry analyses provided useful information on factors predicting earlier discontinuation in a real-world setting. Though targeted agents were shown to be cost-effective treatments in high-income countries, the out-of-pocket expenses may limit accessibility to these drugs, and the overall expenditure for new drugs in CLL is projected to increase substantially, posing an issue for sustainability. This being said, the choice of a finite-duration treatment based on venetoclax-containing regimens or treatment until progression with BTKi is today possible in high-income countries, and the therapy choice drivers are represented by coexisting medical conditions rather than age, patient expectations, logistics, and sustainability.

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“…A recent study revealed that the overall incidence of CLL/SLL is increasing, most rapidly in East Asia [ 7 ]. Additionally, CLL/SLL has a heterogeneous clinical course influenced by cytogenetic aberrations [ 8 , 9 ] and partly by ethnicity [ 10 , 11 ]. CLL/SLL incidence is at least a 20-fold lower in Asian countries than in Western regions, therefore, real-world data is limited, especially in Korea [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Treatment pattern of chronic lymphocytic leukemia/small lymphocytic lymphoma in Korea: a multicenter retrospective study (KCSG LY20-06)

Kim¹,

Kim²,

Kang³

et al. 2023

Korean J Intern Med

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Background/Aims: Little attention is paid to chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) in Korea due to the rarity of the disease. With its rising incidence, we aimed to evaluate recent changes in treatment patterns and survival outcomes of patients with CLL/SLL.Methods: A total of 141 patients diagnosed with CLL/SLL between January 2010 and March 2020 who received systemic therapy were analyzed in this multicenter retrospective study.Results: The median patient age was 66 years at diagnosis, and 68.1% were male. The median interval from diagnosis to initial treatment was 0.9 months (range: 0–77.6 months), and the most common treatment indication was progressive marrow failure (50.4%). Regarding first-line therapy, 46.8% received fludarabine, cyclophosphamide, plus rituximab (FCR), followed by chlorambucil (19.9%), and obinutuzumab plus chlorambucil (GC) (12.1%). The median progression-free survival (PFS) was 49.3 months (95% confidence interval [CI], 32.7–61.4), and median overall survival was not reached (95% CI, 98.4 mo– not reached). Multivariable analysis revealed younger age (≤ 65 yr) (hazard ratio [HR], 0.46; p < 0.001) and first-line therapy with FCR (HR, 0.64; p = 0.019) were independently associated with improved PFS. TP53 aberrations were observed in 7.0% (4/57) of evaluable patients. Following reimbursement, GC became the most common therapy among patients over 65 years and second in the overall population after 2017.Conclusions: Age and reimbursement mainly influenced treatment strategies. Greater effort to apply risk stratifications into practice and clinical trials for novel agents could help improve treatment outcomes in Korean patients.

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Influence of racial and ethnic identity on overall survival in patients with chronic lymphocytic leukemia

Cited by 6 publications

References 6 publications

Mortality trends of chronic lymphocytic leukaemia in the United States with the emergence of targeted therapy

Mortality trends of chronic lymphocytic leukaemia in the United States with the emergence of targeted therapy

First-Line Treatment of Older Patients with CLL: A New Approach in the Chemo-Free Era

Treatment pattern of chronic lymphocytic leukemia/small lymphocytic lymphoma in Korea: a multicenter retrospective study (KCSG LY20-06)

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