Introduction:
Black patients with cutaneous T-cell lymphoma (CTCL) have increased risk of mortality compared to other racial groups.
Methods:
We performed a retrospective review of patients seen at Emory to assess racial differences in treatment patterns and their association with outcomes. Therapies were categorized into chemotherapy, traditional CTCL therapy (retinoids, interferon, photopheresis, and oral methotrexate), and novel agents (mogamulizumab, brentuximab vedotin, and clinical trials). The association between overall survival (OS) and race, stage, and treatment category was assessed using univariate and multivariable analysis for significant factors.
Objectives:
We investigated treatment patterns among patients with CTCL to better understand the role of treatment selection as a potential driver of racial disparities.
Results: The cohort was comprised of 315 patients with a histopathologic diagnosis of mycosis fungoides (MF), Sezary syndrome (SS), or CTCL not otherwise specified seen at the Winship Cancer Institute of Emory University from 2000-2023. 53.6% of patients identified as Black and 46.4% white. Median age at diagnosis was 59.5 years (range, 12-91). Black patients had an earlier age of diagnosis compared to white (median 50 years vs. 63, p<0.001). The majority (78.1%) had a pathological diagnosis of MF. 53.4% of patients had advanced-stage disease of 2b or higher at diagnosis. In the unmatched cohort, Black patients were more likely to receive novel agents compared to white (30.8% vs. 19.2%, p=0.018). However, after matching by age and stage, black patients were less likely to receive novel agents (p=0.019). Patients with advanced-stage disease had improved OS if they received novel agents (HR 0.39, 0.24-0.65, p<0.001).
Conclusions:
These findings suggest that treatment patterns could play a role in the racial differences in clinical outcomes in CTCL.
