Reducing Racial Disparities in CLL Treatment by Addressing Key Social Barriers: Joanna Rhodes, MD, MSCE

Despite clear NCCN guidelines for frontline chronic lymphocytic leukemia (CLL) therapies, significant racial and ethnic disparities persist in access to preferred treatments, says Joanna Rhodes, MD, MSCE, director of the lymphoma program at the Rutgers Cancer Institute and the assistant head of lymphoma at Robert Wood Johnson Medical School.

These findings were presented at the American Society for Hematology (ASH) 2025 meeting.

This transcript was lightly edited; captions were auto-generated.

Transcript

What do your findings reveal about the magnitude of racial and ethnic inequities in access to NCCN-preferred novel therapies for CLL?

Our study demonstrated that there are differences based off of race for patients with CLL receiving what are the NCCN-recommended treatment therapies, which are, for right now, in the frontline setting, second-generation BTK [Bruton tyrosine kinase] inhibitors and venetoclax-based regimens for patients who are Black or Hispanic in comparison to White patients, with more Black patients receiving ibrutinib compared to the NCCN-preferred regimens. For Hispanic patients, [there is] actually a preponderance or an increase in chemoimmunotherapy use.

I think that this is an important finding. We know that the NCCN guidelines are actually a very common way in which up-to-date practice updates are disseminated to oncologists, because the field is changing so rapidly, and even despite having these recommendations out there, there are differences based off of race that we found in what patients are actually receiving in clinical practice.

How did residential segregation emerge as a key mediator of treatment inequities in your analysis?

I thought that this was a really interesting one. One of the things that we looked at—the way that this was done was using a multi-mediation analysis—and one of the frameworks that we use was the 20-area level on social determinants of health factor that measures something called social deprivation, which is defined as limited access to economic, social, neighborhood, physical, or health care resources, and there are 20 different units. Within our 20 different areas within our study, we found that racial residential segregation—meaning that the residence is predominantly [of one] race or ethnic [group] in a single area, whether or not it's White, Black, Hispanic, or diverse—no internet access, no vehicle ownership, and no health insurance coverage were associated with lower access [to] or lower use of NCCN-recommended or preferred frontline regimens in CLL.