Academic Cancer Centers See Longer Survival in CLL, MCL Than Community Centers

Patients with chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL) who received care in academic cancer centers had significantly better survival outcomes than those treated in community settings in a new real-world study.1

Published in Leukemia & Lymphoma, these findings highlight the role of practice setting in patient outcomes and add to the conversation around treatment gaps in the US.

“This study specifically addressed site of care, a factor that had been suggested in prior research as related to improved outcomes among patients with CLL or MCL,” the study authors wrote. “The results demonstrate a strong statistically significant relationship between care in an academic practice setting and improved clinical outcomes in both diseases.”

The authors also acknowledged the challenges of access and equity in cancer care. | Image credit: Chinnapong – stock.adobe.com

To come to these findings, researchers evaluated nationwide data from more than 9700 patients with either CLL (n = 6372) or MCL (n = 3411) who received systemic therapy between 2013 and 2022. Among these patients, 13.9% with CLL and 22.2% with MCL were treated in academic settings. The analysis revealed a substantial gap in survival. From the start of first-line therapy for CLL, the median overall survival (OS) was not reached in academic centers compared with 80.5 months in community settings. Meanwhile, for MCL, the median OS was 95.6 months in academic settings and 68.7 months in community settings.

Academic centers were more likely to treat younger patients and those with high-risk disease features, such as del(17p) mutations in CLL, and had significantly higher rates of clinical trial enrollment for both cancer types. After adjusting for baseline differences, academic centers still saw significantly longer survival outcomes for their patients than community-based practices. Patients with CLL and MCL treated in academic settings were also more likely to participate in a clinical trial than their counterparts in community settings. However, this study did not evaluate any causal relationship between trial participation and patient outcomes.

Covalent Bruton tyrosine kinase inhibitors were more frequently used in both first-line and later-line settings for MCL in academic centers than in community sites, though the duration of treatment was similar across settings. Additionally, the overall use of BCL2 inhibitors (BCL2i) and PI3K inhibitors (PI3Ki) remained low in both settings, with less than 20% of patients with CLL and 10% with MCL receiving BCL2i while PI3Ki use fell below 1%.

The researchers also found a large gap in chimeric antigen receptor (CAR) T-cell therapy utilization between settings, as well as an overall lack thereof. The use of CAR T-cell therapies is associated with improved outcomes in MCL, yet only 6.2% of patients in academic and 1.3% in community practices received the treatment. However, the researchers said this low utilization, while still a concern, does not explain the survival gap between sites of care.

“Similarly, while BCL2i-based treatment has demonstrated efficacy, exposure to these therapies was only observed in a small subset of patients in either cohort," they explained. “Therefore, this was also not likely to be sufficient to impact the differences observed in overall survival.”

Despite the advantages of academic settings shown by this study, the authors also acknowledged the challenges of access and equity. Patients in community settings were generally older and more likely to be on Medicare or uninsured, raising questions about disparities in specialized cancer care—a topic of growing importance as these disparities worsen in rural populations where patients have higher rates of risk factors and cancer centers are often left behind in the latest advancements.2

“Race and ethnicity differences by site of care raise concerns about equity and how the site of care differences may contribute to potential differential outcomes by race,” the authors emphasized.1 “However, prior research has shown the lack of significant differences in outcomes by race in this same database. The relationship between site of care and race is deserving of further examination in future research.”

While the study establishes a clear association between academic settings and better survival, the reasons for this advantage remain complex. The authors suggest factors such as multidisciplinary tumor boards and higher provider experience may play a role, though more research is needed to better understand the underlying mechanisms.

References

1. Bruno DS, Khanal M, Li X, Escalon MP, Winfree K, Hess LM. Clinical trial participation, clinical care, and patient outcomes by practice setting: a real-world database analysis of patients with chronic lymphocytic leukemia or mantle cell lymphoma. Hematology. 2025;30(1):2457809. doi:10.1080/16078454.2025.2457809
2. Bhatia S, Landier W, Paskett ED, et al. Rural-urban disparities in cancer outcomes: opportunities for future research. J Natl Cancer Inst. 2022;114(7):940-952. doi:10.1093/jnci/djac030