Background: Chronic lymphocytic leukemia (CLL), the most prevalent leukemia in western countries, is associated with highly variable clinical outcomes. This study aims to evaluate whether patients with CLL treated at Commission on Cancer accredited academic centers (ACs), which offer high clinical volume, clinical trial access, and postgraduate physician education, have improved survival compared to non-academic centers (NACs). Methods: The National Cancer Database (NCDB) was used to identify CLL patients diagnosed between 2004-2018. Demographic and treatment characteristics were compared between center categories with binary logistic regression for odds of receiving CLL treatment at an AC. Survival analysis was completed with Kaplan Meier and multivariate Cox regression, adjusted for the only available disease-related characteristics in the NCDB, age and Charlson-Deyo comorbidity score, to compare overall survival (OS). Results: Of the 98,186 patients identified, 33.3% were treated at ACs. Patients treated at ACs were younger than those treated at NACs (median age 67 vs. 71 years, p<0.001). ACs were more likely to treat Black and other minority patients, with Black patients representing 9.7% vs. 6.3% of AC vs NAC patients (p<0.001). ACs were more likely than NACs to treat privately insured (39.1% vs. 30.3%), uninsured (3.2% vs.2.0%) and patients on Medicaid (4.1% vs. 2.9%) (p<0.001), as well as patients from the highest quartiles of income (OR 1.46), and education (OR 1.12), when referenced to lowest quartiles (p<0.001). ACs were more likely to manage patients with surveillance versus NACs (53.7% vs. 45%, p<0.001). With a median follow up of 4.3 years, median OS at ACs was significantly improved when compared to NACs, with a median OS of 11.0 years (CI 10.5-11.3) vs. 8.2 years (CI 8.1-8.3), respectively (p<0.001). Survival benefit was maintained at both 5-years (73% vs. 66%) and 10-years (53% vs. 43%) (both p<0.001). On multivariate analysis adjusted for age and comorbidity, management of CLL patients at ACs was an independent factor for improved OS (HR 0.87, CI 0.85-0.89, p<0.001). Conclusions: In this study of a large population of CLL patients, there is significant demographic and socioeconomic variation between CLL patients treated at ACs and NACs. While our study is limited by the available disease and treatment level data available, the improved OS benefit of CLL patients managed at ACs suggests possible differences in treatment and clinical trial availability, and supportive care management. Further investigations into the factors contributing to such disparities would be beneficial to help standardize care and improve outcomes.

*Adjusted for age, Charlson-Deyo comorbidity score.