Authored by Ann Liu, PhD
Medically Reviewed by Brian Koffman, MDCM (retired), MSEd
The Bottom Line:
Hodgkin lymphoma transformation is a rare type of Richter’s transformation in which CLL / SLL turns into Hodgkin lymphoma. Prior CLL / SLL therapies do not affect the outcomes of patients with Hodgkin lymphoma transformation, and patients generally respond well to Hodgkin lymphoma therapies.
Who Performed the Research and Where Was it Presented:
Dr. Paul Hampel from the Mayo Clinic and colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting 2024.
Background:
Richter’s transformation is a rare complication of chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), where the disease develops into an aggressive lymphoma, most commonly diffuse large B cell lymphoma (DLBCL). The DLBCL form of Richter’s transformation has a very poor prognosis, and previous research has shown that patients who received prior treatment for their CLL / SLL (chemoimmunotherapy or targeted therapies) had worse outcomes than patients who had no treatment before developing Richter’s transformation. However, approximately 10% of patients with Richter’s transformation develop Hodgkin lymphoma instead of DLBCL. This is a rare presentation of an already rare condition. This study aimed to look at survival outcomes of Hodgkin lymphoma transformation patients, specifically patients who had not received prior chemotherapy.
Methods and Participants:
This was a retrospective study looking at patient records from 12 academic medical centers, and it included patients with Hodgkin lymphoma transformation who had never received chemotherapy for treatment of their CLL / SLL.
Results:
- A cohort of 402 patients with Richter’s transformation who had not received prior chemotherapy was identified, and 41 (10%) of those patients had Hodgkin lymphoma transformation.
- The median time from CLL / SLL diagnosis to being diagnosed with Hodgkin lymphoma was five and half years in treatment naïve patients and 4.2 years in those who had non-chemotherapy to treat their CLL / SLL.
- Twelve patients had their Hodgkin lymphoma and CLL / SLL diagnosed simultaneously, 10 patients had Hodgkin lymphoma transformation without prior CLL / SLL treatment, and 19 patients had Hodgkin lymphoma transformation with previous non-chemotherapy CLL / SLL treatment.
- Among patients who received prior targeted therapies for CLL / SLL treatment, 17 were on a BTK inhibitor at the time of Hodgkin lymphoma diagnosis, and one was on a BCL2 inhibitor.
- There was no difference in overall survival between patients with Hodgkin lymphoma who had not received prior CLL / SLL treatment, patients with Hodgkin lymphoma who had previously received targeted therapies for CLL / SLL, and patients who received their Hodgkin lymphoma and CLL / SLL diagnoses at the same time.
- Almost all patients (n=39) were treated with Hodgkin lymphoma therapies (mainly ABVD chemoimmunotherapy), and the overall response rate was 78%.
Conclusions:
Patients with Hodgkin lymphoma transformation generally have a better prognosis than patients with the DLBCL form of Richter’s transformation. Prior CLL / SLL therapy does not negatively affect survival outcomes for these patients, and they generally respond well to standard Hodgkin lymphoma therapies. While there was a considerable range of when CLL / SLL patients were diagnosed with Hodgkin lymphoma (four months to >17 years), most were diagnosed within five years of their CLL diagnosis.
Links and Resources:
Watch the interview on the abstract here:
You can read the actual ASH abstract here: Hodgkin Lymphoma Transformation in Patients Who Received No Prior Chemotherapy for CLL / SLL: Outcomes from a Multicenter Retrospective Study in the Modern Era of Therapy
