Awareness and real-world practices in chronic lymphocytic leukemia: insights from a nationwide survey of Korean hematologists.

[PURPOSE] The incidence of chronic lymphocytic leukemia (CLL) is rising in Korea; however, clinical management often diverges from international guidelines due to limited clinical experience, restricted access to diagnostics, and delayed reimbursement for novel agents. This study aimed to assess Korean hematologists' awareness, clinical practices, and perceived barriers in the management of CLL.

[METHODS] A nationwide, web-based survey was conducted between May 29 and June 19, 2023, targeting hematologists registered with the Korean Society of Hematology who were actively treating patients with CLL. The 15-item questionnaire addressed clinical experience, treatment approaches, use of bruton tyrosine kinase inhibitor (BTKi), awareness and application of prognostic tools, access to molecular diagnostics, reimbursement priorities, and perceived need for national clinical guidelines. A total of 89 hematologists completed the survey.

[RESULTS] Patient caseloads varied, with 41.6% of physicians managing 10-19 patients over the prior six months. Treatment patterns were heterogeneous, and undertreatment was commonly attributed to patient refusal (33.7%) and advanced age (10.1%). Despite reimbursement limitations, 15.7% reported prescribing BTKis in ≥ 40% of their patients, although adverse events and intolerance were frequently cited challenges. Awareness of prognostic indices was high, yet their implementation was inconsistent. Access to essential molecular diagnostics was suboptimal; 53% lacking Immunoglobulin heavy-chain variable region gene (IGHV) mutation testing and 43% lacked measurable residual disease (MRD) assessment, whereas TP53 testing was broadly available. Nearly half of the respondents prioritized second-generation BTKis for first-line reimbursement, and 94.4% endorsed the need for Korean-specific clinical guidelines.

[CONCLUSION] This survey highlights gaps between international recommendations and Korean real-world practice, emphasizing the need for improved diagnostic availability, timely reimbursement of targeted agents, and development of Korea-specific clinical guidelines tailored to the Korean context.