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ASH 2021: Dr. Jennifer Woyach on Predicting Development of Richter’s Syndrome After Ibrutinib Treatment

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Richter’s syndrome (a.k.a. Richter’s transformation) is a rare complication of chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), where the cancer cells transform into a much more aggressive lymphoma. It is associated with very rapid disease progression, limited therapeutic options, and poor survival. In addition, some of the traditional tests physicians use to diagnose Richter’s syndrome, such as PET-CT scans, are not as helpful after treatment with targeted therapies such as ibrutinib. Thus, researchers are interested in finding out whether there are other ways of predicting which patients might develop Richter’s syndrome.

At the annual meeting of the American Society of Hematology (ASH) 2021, Dr. Anthony Mato, Director of the CLL program at Memorial Sloan Kettering Cancer Center in New York, interviewed Dr. Jennifer Woyach, a hematologist-oncologist at the James Cancer Center of the Ohio State University in Columbus, OH. They discussed the results of a study looking at which features might predict the future development of Richter’s syndrome in patients treated with ibrutinib.

Takeaways:

  • This study was trying to understand if certain clinical characteristics can help predict which patients might be most at risk for developing Richter’s syndrome.
  • We already know that patients who have used multiple prior therapies and have high-risk genetic features are at increased risk of developing Richter’s syndrome.
  • For this study, researchers looked back at the records of about 600 patients who had previously been treated with ibrutinib.
  • Approximately 180 of these patients have their disease progress on ibrutinib, and over time about 75 patients developed Richter’s syndrome.
  • Among the patients whose disease progressed on ibrutinib, those whose lymph nodes were getting bigger (lymphadenopathy) but didn’t necessarily have increases in white blood cell counts seemed to be at the highest risk of developing Richter’s syndrome in the future.
  • For patients who relapse on ibrutinib with enlarging lymph nodes, a lymph node biopsy should be considered to check for Richter’s syndrome to ensure it is caught early on.

Conclusions:

Early detection can be crucial for treating cancers, especially Richter’s syndrome, which is challenging to treat. This study shows that lymph node size may be an especially important clinical characteristic to monitor in patients whose disease is progressing on ibrutinib therapy.

Please enjoy this interview with Dr. Woyach from the ASH meeting held in December 2021 in Atlanta, GA, and virtually.

You can read the actual abstract here: Utilizing Clinical Features of Progression to Predict Richter’s Syndrome in Patients with CLL Progressing after Ibrutinib.

Take care of yourself first.

Ann Liu, PhD