Influence of Racial and Ethnic Identity on Overall Survival in Patients with Chronic Lymphocytic Leukemia

Abstract

Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia, with the highest incidence in the White, non-Hispanic population. To better understand underrepresented minority CLL patients, patients diagnosed with CLL from 2004-2018 were identified in the National Cancer Database. Of 97 804 CLL patients, 90.7% of patients were White, 7.6% Black. Compared to White patients, Black patients were younger (median age 66 years vs. 70 years), more likely to have ≥1 comorbidity (27.9% vs. 21.3%), more likely to receive CLL-directed therapy at diagnosis (35.9% vs 23.6%; p<0.001), and had a shorter median OS of 7.0 years (95% CI 6.7-7.3) compared to White patients (9.1 years [95% CI 9.0-9.3]), p<0.001). On multivariate analysis, Black race was independently associated with shorter OS (HR 1.51 [95% CI 1.46-1.57], p<0.001), which was also demonstrated in a propensity score matched sample (matched by age, comorbidity, and socioeconomic features), where Black patients had shorter OS compared to White patients (HR 1.30 [95% CI 1.23-1.37, p<0.001]). In the largest study to date describing minority CLL patients, we found significantly reduced survival in Black CLL patients, highlighting the need for targeted efforts to provide equitable outcomes.