iwCLL 2017: Dr. Pagel on PD 1 Inhibitors for Richter’s Transformation in CLL

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From iwCLL 2017, Dr. John Pagel from Swedish Hospital in Seattle discussed some exciting news about one of the most urgent unmet needs in chronic lymphocytic leukemia (CLL). Richter’s Transformation (RT) or Richter’s Syndrome is when CLL turns bad and transforms into usually an aggressive diffuse B cell lymphoma.

Here is a refresher on RT by Dr. Wiestner that is worth reading to give perspective to this promising research.

Here is an earlier interview with Dr. Pagel that goes into more details on checkpoint inhibitors to provide some helpful background on the advancing science on PD-1 (programmed T cell death 1) and PDL-1 (programmed T cell death ligand) inhibitors. Molecules that bind to a receptor are called ligands.

Take Away Points:

• Richter’s Transformation (RT) generally does not respond to ibrutinib and too often the response to powerful chemotherapy is not ideal.
• PD-1 inhibitors or checkpoint inhibitors remove the brakes from the T cells that are a potent part of the immune system to control cancer.
• Though they don’t work well in CLL, encouraging results have been reported with using PD-1 inhibitors in RT in different trials at Mayo and MD Anderson.
• More needs to be done to offer RT patient durable remissions.

Here is a link to the Mayo abstract .

Here is a link to the MDACC abstract.

Enjoy my conversation with Dr. Pagel or read the transcript here.

Brian Koffman, MD 8-15-17