Addressing Disparities in Chronic Myeloid Leukemia (CML) Care

Tyrosine kinase inhibitors (TKIs) transformed CML into a manageable chronic condition, but disparities persist in access, adherence, and outcomes.

Documented Disparities

Racial/ethnic: Black and Hispanic patients: later diagnosis, lower TKI adherence, higher discontinuation, worse survival vs. White patients.
Socioeconomic: Low income/education/uninsured: delayed presentation, less specialist access, higher toxicity, financial toxicity.
Geographic: Rural/underserved areas: fewer hematologists, travel barriers, limited clinical trial access.
Age: Older adults: underrepresented in trials; dose reductions, less potent TKIs; frailty/comorbidity balancing.
Sex: Women: more adverse effects (pleural effusion with dasatinib); pregnancy planning complexities.

Structural racism, implicit bias, insurance gaps, transportation, health literacy, medication cost (even with insurance), trial eligibility criteria.

System level: Medicaid expansion, oral parity laws, TKI generic availability, telehealth hematology.
Institutional: Disparities dashboards, navigation programs, financial counseling, culturally tailored education.
Provider: Bias training, shared decision-making, adherence support (pill boxes, apps, pharmacy sync).
Research: Mandate diverse enrollment; pragmatic trials in community settings; real-world evidence generation.
Patient empowerment: Peer support, advocacy organizations (LLS, CML Society), treatment-free remission (TFR) counseling.

Equitable CML care requires multi-stakeholder commitment. Every patient deserves the full benefit of the TKI revolution.