b'u From Page 83a result, VA expanded CLL to include all chronic B-cellleukemiasasrelatedtoexposureto Agent Although survival rates have Orange or other herbicides during military service. VAs final ruling on this association took effect onimproved overall, outcomes in Oct. 30, 2010. CLL demonstrate inferior survival Mitigating Disparities among Black patients, with a The authors of the study showing treatment disparity advised, Managed care providers should consider5-year survival rate of only 64%, racial, socioeconomic, and cultural factors that mayaccording to the authors, who drive disparities, such as these, so that they can de-sign and implement strategies to prevent and miti- noted that the overall survival rate gate these disparities. is greater than 80%. While CLL has a median age of diagnosis of 70 years and older white males have the greatest inci- study authorsdence, Black males also are at risk and tend to be diagnosed at a younger agemean age at diagnosis of 67 vs. 70 years).Althoughsurvivalrateshaveimprovedover- The study noted that, for patients with high-risk all, outcomes in CLL demonstrate inferior survivaldisease(patientswithdel[17p],del[11q],unmu-among Black patients, with a 5-year survival rate oftatedIGHV,ormutatedTP53),regardlessofage only 64%, according to the authors, who noted thatand comorbidities, the use of NAs is recommended the overall survival rate is greater than 80%. Blackbyclinicalguidelines.AstheincidenceofCLL patientshavealsopresentedwithfactorsassoci- increases,withanolder,morediversepopulation ated with worse outcomes, including lower medianundergoingtreatment,useofNAsisexpectedto hemoglobin levels, higher 2-microglobulin levels,rise, it added.and more unmutated IGHV gene expression, ZAP70Within the VHA, according to VA Press Secretary expression, and chromosome 17p or 11q deletion. Terrence Hayes,treatment options for CLL are deter-Theauthorsadvisedthattreatmentoptionshavemined by mutation status and the age of the patient. expanded since the period involved in their study,Mostly, CLL is treated using oral BTK inhibitors explaining, With regard to CLL, the NAs ibrutinibindefinitelyvstimedependenttherapywhichis (Bruton tyrosine kinase inhibitor, US Food and DrugatargetedoralpillandaCD20monoclonalanti-Association-approved for CLL in February 2014),body for one year, Hayes said in response to a U.S. idelalisib(PI3kinaseinhibitor,July2014),andMedicine question. If a patient is young and has a venetoclax (BCL-2 inhibitor, April 2016) functionpositive IgVH mutation, it is still recommended that at the gateway of dysregulated enzyme pathways.they receive chemotherapy with the FCR regimen. Randomizedclinicaltrials,includingRESONATEChemotherapy is not recommended in patients that (relapsed/refractoryibrutinib)andRESONATE-2carry a TP53 mutation as the response rate is gener-(first-line ibrutinib), have demonstrated the ability ofally low.ibrutinib to improve survival compared with chemo- 1Lucero KT, Obodozie-Ofoegbu OO, Nooruddin Z, Ryan K, Castillo therapy (CT)-based treatments. A follow-up 6-yearA, Moore AM, Jones X, Frei CR. Health disparity in use of novel analysisoftheRESONATEtrialreportedstatisti- agents for first-line therapy in Black and White patients with chronic callysignificantimprovementinprogression-freelymphocytic leukemia in the Department of Veterans Affairs. J Manag Care Spec Pharm. 2023 Apr;29(4):420-430. doi: 10.18553/survival, overall survival, and overall response ratejmcp.2023.29.4.420. PMID: 36989449. with ibrutinib. Importantly, these NAs are available as oral therapies, as opposed to traditional chemo-therapies, most of which are intravenous only.90'