ABSTRACT Objectives Targeted therapies have markedly improved outcomes in chronic lymphocytic leukaemia (CLL), particularly among patients with TP53 alterations and unmutated IGHV. However, real‐world studies report persistent inequalities in access to optimal care. This is the first study aimed at identifying gaps between clinical practice and evidence‐based recommendations in Portuguese patients with CLL, focusing on treatment patterns, molecular testing, and clinical outcomes. Methods: A multicentre, retrospective, cohort included all consecutive CLL patients treated between 2018 and 2020 in five Portuguese hospitals. Demographic, clinical, and genetic data were collected, including therapies up to third‐line, toxicities, response, relapse/progression, and survival. Results Among 298 patients, chemoimmunotherapy (FCR/BR) was most frequent (38%), followed by targeted agents (32%). TP53 /del(17p) testing occurred in 70% and IGHV in 42%, with significant inter‐centre variability. Older age (> 65 years) was independently associated with lower testing rates. Despite guidelines, targeted therapies were underused, particularly in high‐risk (77%) and early‐relapsing (43%) patients. Five‐year overall survival was 73% in first‐line and 55% in relapsed/refractory treatment subgroups. Conclusions We identified delayed and inconsistent adoption of molecular testing and targeted therapies in Portugal, which likely contributed to the suboptimal survival observed. National guidelines adapted to local resources could harmonize CLL care and improve outcomes.
Esteves et al. (Mon,) studied this question.