The Value of Real-World Data in CLL: Margaret Krackeler, MD

Real-world evidence has a growing role in guiding treatment decisions for chronic lymphocytic leukemia (CLL), Margaret Krackeler, MD, of Kaiser Permanente Northern California, explained in an interview with The American Journal of Managed Care® discussing findings from a real-world study evaluating outcomes with zanubrutinib across the Kaiser Permanente health system.

Krackeler emphasized the collaborative effort required to successfully transition patients to newer therapies. Pharmacy teams, providers, and patients worked closely together to ensure continuity of care while adopting evidence-based updates to the treatment algorithm. This experience demonstrated how integrated health systems can implement rapid practice changes when supported by robust data, Krackeler said.

She noted that real-world research plays a critical role in informing these decisions, particularly because it reflects outcomes that directly affect medication utilization, adherence, and treatment tolerability. Unlike clinical trials, which often include narrowly selected populations, real-world data capture how therapies perform in everyday practice—an especially important consideration for chronic diseases such as CLL that require long-term treatment.

“I do hope that this study helps contribute to this field of real-world research that I think a lot of our oncology field is moving toward,” Krackeler said.

Addressing the broader value of real-world data, Krackeler pointed to the study’s scale as a key strength. At the time of publication, it was the largest real-world cohort of patients with CLL treated with zanubrutinib, encompassing 281 patients within Kaiser Permanente Northern California. Although she acknowledged the significance of this sample size, she also stressed the potential impact of even larger datasets in further clarifying the tolerability and effectiveness of newer therapies outside controlled trial settings.

Krackeler noted that real-world evidence is becoming increasingly central to oncology practice, helping clinicians and health systems better understand how emerging treatments translate into real patient outcomes and informing evidence-based, value-driven care decisions that lead to the best possible outcomes for patients.

Reference

Krackeler ML, Chee BH, Orchanian AK, et al. Real-world treatment patterns and outcomes of zanubrutinib in chronic lymphocytic leukemia and small lymphocytic leukemia (CLL/SLL). Cancer Med. Published online October 25, 2025. doi:10.1002/cam4.71300