Introduction:
Racial disparities in cutaneous T-cell lymphoma (CTCL) outcomes persist, with Black patients experiencing higher mortality. While novel agents like mogamulizumab and brentuximab vedotin improve survival, it remains unclear if differential access to these therapies contributes to outcome disparities.
Methods:
We conducted a retrospective cohort study of 315 patients with mycosis fungoides, Sézary syndrome, or CTCL-NOS at a single academic center (2000-2023). We analyzed treatment patterns receipt of categorized as novel agents, traditional therapies, or chemotherapy and overall survival (OS) by race. A propensity-matched analysis balanced for age and disease stage was performed.
Results:
The cohort comprised 169 Black patients (53.6%) and 146 White patients (46.4%). Black patients were diagnosed significantly younger (median 50 vs. 63 years, p< 0.001). In the unmatched cohort, Black patients were more likely to receive novel agents (30.8% vs. 19.2%, p=0.018). However, after propensity matching, Black patients had significantly lower odds of receiving novel agents (OR 0.27, 95% CI 0.14-0.53, p< 0.001). Receipt of novel agents was independently associated with improved OS in advanced-stage disease for the entire cohort (HR 0.39, 95% CI 0.24-0.65, p< 0.001), with similar survival benefits observed in both racial groups.
Conclusions:
Despite a similar survival benefit from novel agents, Black patients with CTCL were less likely to receive these therapies when matched for age and disease stage. These findings identify inequitable treatment patterns as a potential driver of racial disparities in CTCL outcomes, highlighting the need for interventions to ensure equitable access to advanced therapies.
