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The Impact of Age, Gender and Race on CLL

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Published on November 25, 2020

Can Age, Gender and Race Affect CLL Outcomes?

Can a patient’s age, gender or race affect their chronic lymphocytic leukemia (CLL) treatment journey and prognosis? Watch as a panel of CLL experts and advocates address this question.

Dr. Paolo Caimi, Hematologist/Oncologist at University Hospital (UH) Cleveland Medical Center, Dr. Brian Hill, Director of the Lymphoid Malignancies Program at Cleveland Clinic Taussig Cancer Institute and Host/Patient Advocate Michele Nadeem-Baker discuss how gender can affect CLL dosage, age can be a determining factor in the type of treatment one receives and whether or not race has an impact on CLL outcomes.

This series is sponsored by AbbVie, Inc. and Genentech, Inc. This organization has no editorial control. It is produced by Patient Power, and Patient Power is solely responsible for program content.

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Transcript | The Impact of Age, Gender and Race on CLL

Does Gender Affect the Dosage of a CLL Drug?

Dr. Caimi: Women and men are different in how they process certain drugs. But usually, it's just by difference in size, but the body composition is slightly different. We know that there may be a little bit of a difference in how they clear certain antibodies. But we also know that women tend to have a smaller body size than men. Occasionally when I have somebody who is very petite, I tend to think that they may tend to maybe at the higher end of the range of dose particularly with those drugs. That no matter if I'm seeing somebody who is seven feet tall and 300 pounds heavy versus somebody who is five feet tall and less than a hundred pounds, I will give them the same dose. Usually, the IV chemotherapy drugs are done by considering your weight and height by something we call your body surface area.

But these newer medications that the aim has been primarily, I think simplifying the dosing. And I think in some of the patients who are the extremes, in particular those who smaller may be having a slightly higher amount of medication. Most people don't necessarily experience more side effects, but something that we have to adjust for medication and keep an eye on. I think it's much more important to talk about drug interactions and keep an eye on the patient closely. I think what we do is we just monitor you and make sure that there are no adverse events. And if that goes, we continue going, if there's something, we adjust, we go down.

Carol Preston: For women who are pregnant and actually deliver a child while having been diagnosed with CLL. What does the future possibly hold for their kids likely developing CLL or other issues? And that is if the mother has CLL. Have you seen anything?

Dr. Caimi: In general, we have little information about how the safety of these drugs during pregnancy and we tend to either avoid them or devise a specific dosing plan for a pregnant patient. I think like Christopher D'Andrea, mentioned already that the genetic association of CLL or the inheritable component to CLL is very small if at all.

So, it tends to be that your risk, if you're related to somebody with CLL, your risk is probably maybe a very tiny smidge higher than the normal population versus these big genetic cancers that we see in people with BRCA mutations that are 50 times the general population. So, I think your risk is probably not too significantly increased by something that should take [inaudible] from. And I don't think it would, the association with autism or other things should be, I don't think that we have any evidence for that.

What Symptoms of CLL Should People Watch For?

Christopher D'Andrea: That's another reason to follow up with routine medical care, even if you are otherwise healthy. And by that meaning going to visit your primary care doctor every one to two years, having routine blood work checked, having your blood pressure checked and your cholesterol, things like that. We don't know of any utility in doing screening for CLL at this time. Right? So, you wouldn't have your children go and have to get their blood drawn every few months or every year to check specifically for CLL, just because you had it.

 So, I tend to take it more from the, again, another important thing for primary care, just as I said before, if there's a family history of diabetes or high blood pressure or heart disease, things like that, these are all strong indicators that if this condition runs in your family, it can potentially be caught early. And if it's caught early, then that's usually a good thing.

Carol Preston: So, you're basically creating a baseline then, from which to proceed. And this way, they'll know what things look like in 2018. So, in 2020, if there are any more changes, or 2021, there'll be a lot better opportunity to nail it down.

Christopher D'Andrea: Absolutely, absolutely.

Is Age a Factor in Decision-Making for CLL Treatment?

Dr. Hill: Chemotherapy is kind of off the table if you're, let's say elderly or frail. So, if you're 80 years old and need treatment for CLL, we're probably not going to use traditional chemotherapy. For everyone else who's walking into the cancer center, whether they're 30, 40, 50, or 60s, I think all options are on the table.

I have had younger patients who are a little less enthusiastic about, let's just say BTK inhibitors because of the requirement for ongoing therapy. And they know they're going to have many, let's say decades ahead of them. And do they really want to be on medication for decades if we don't really know what the very long-term implication of that will be? So, it's a personal decision. And I usually, I try to get patients involved in the sort of laying out the options about time-limited versus indefinite therapy. But I don't think there's a cutoff that says you can't use an indefinite therapy just because you're under the age of 50 let's say.

Does Race Impact CLL Outcomes?

Dr. Caimi: The prognosis for patients who are African American who have good access to healthcare should be very comparable to people who are of other racial or socioeconomic sources. In general, in CLL the difference is not that important as it is in other cancers of the blood. What is interesting is that there's some geographic variation, meaning that Europe and the Americas have much more CLL versus Asia where CLL is very rare. And so, in some people you really don't see it as much, but the racial difference sometimes is more related to the capacity to access to healthcare insurance and good support.

And I would expect that the prognosis should be the same. We would look at their genetics and we would look at the same reasons and expect them to do excellent. I tell all my patients that with CLL I expect them to do very well.

Michele Nadeem-Baker: Any data on other population groups like within the Latin population? Would it be the same as what you're saying? Or different.

Dr. Caimi: So, it has to do a little bit with tolerability of treatments, occasionally. People who are from where I come from, South America, tend to tolerate chemotherapy a little bit worse occasionally, but not necessarily. A little bit of variation in terms of the amount to CLL that you see. I think they also see a little bit less CLL than we do, but the prognosis by race itself is not that different.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.


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