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ASCO 2019: CLL Society Dr. Koffman’s Pick #7 “Stem Cell Transplant in Richter Transformation inn Chronic Lymphocytic Leukemia (CLL)”

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Dr. Brian Koffman, the Executive Vice President (EVP) and Chief Medical Officer (CMO) of the CLL Society, counts down his top ten CLL related abstract from ASCO or the American Society of Clinical Oncology Annual Meeting held May 31 – June 4, 2019, Chicago, IL.

#7

Outcomes of stem cell transplant in patients with Richter transformation

Richter’s Transformation (RT) or Richter’s Syndrome (RS) remains one of the screaming unmet needs in chronic lymphocytic leukemia.

RT is when CLL transforms into a more aggressive leukemia, usually Diffuse Large B-Cell Lymphoma (DLBCL) that generally carries a poor prognosis. For more information on RT, please see this background by Dr. Wiestner of the NIH.

This trial comes out of Mayo Clinic and is on Hematopoietic Stem Cell Transplant (SCT) or “bone marrow transplant” to treat Richter’s. It was led by Dr. Yucai Wang who is doing important translational research on RT.

Takeaways:

  • The outcomes of 24 patient transplant patients were reported.
    • 20 had received autologous (from themselves) SCT
    • 4 had received allogeneic (from matched strangers or siblings*) SCT
  • After a median follow-up of 52.7 months after SCT, there were 10 RT relapses, 4 CLL progression, and 11 deaths (7 RT, 1 CLL and 3 unrelated).
  • The median progression-free survival (PFS) was 28.5 months.
  • The median post-SCT survival was 56.3 months- This is much better than is usually the case with Richter’s.
  • Of particular note were the 4 patients who had the tougher “allo” HCT. Only 1 had a recurrence of their RT** and all 4 remain alive, one now 5 months or almost 10 years after SCT.

Conclusions:

Richter’s Transformation generally carries a dismal prognosis but research with novel agents used in new combinations is changing that. For those well enough to receive and survive a transplant, especially an allogeneic SCT, there is the good news that RT can be beaten based on these data from Mayo.

The numbers are small and more research is needed, but transplants have and will continue to play an important role in offering real hope in Richter’s Syndrome.

Here is my very brief ASCO video:

Here is the ASCO abstract: https://meetinglibrary.asco.org/record/171952/abstract

Thanks for your attention.

Stay strong.

We are all in this together.

Brian

Errata in the video:

*    Allogeneic transplants can be sourced from any matched donor, often a “stranger”, but often a sibling, not only a stranger as I said in the video.

**  One allo patient had  Richter’s transformation, not a Richter’s Transplant. I misspoke, a slip of the tongue. There is no such thing as a Richter’s Transplant.