Authored by Ann Liu, PhD
Medically Reviewed by Brian Koffman (MDCM ), retired. MSEd
The Bottom Line:
Outcomes for patients with Richter transformation remain poor even with the introduction of targeted therapies. There is a significant unmet need for new, more effective treatment strategies for patients with Richter transformation.
Who Performed the Research and Where Was it Presented:
Dr. Jean-Nicolas Champagne from BC Cancer Vancouver and colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting in 2024.
Background:
The treatment landscape for chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) has changed dramatically with the introduction of targeted therapies (a.k.a. novel agents), which target specific proteins that control the growth and survival of cancer cells. These therapies are very different from chemotherapy, which kills all rapidly dividing cells, and targeted therapies have significantly improved outcomes for patients with CLL / SLL. However, patients can still develop Richter transformation, a rare complication of CLL / SLL where the disease turns into an aggressive lymphoma that has a poor prognosis. Little is known about whether the development and progression of Richter transformation have changed with the introduction of targeted therapies. This study looked at the characteristics of patients who developed Richter transformation during the targeted therapy era versus the chemoimmunotherapy era.
Methods and Participants:
This study used information from three different healthcare databases to identify CLL / SLL patients with Richter transformation between 2000 and 2023. Patients were grouped according to whether they were diagnosed with Richter transformation before 2016 (chemoimmunotherapy era) or after 2016 (targeted therapy era). BTK inhibitors were first approved in Canada in 2016.
Results:
- A total of 207 patients with Richter transformation were identified: 132 in the chemoimmunotherapy era and 75 in the targeted therapy era.
- Patients in the targeted therapy era were older (73 vs. 69 years). They had lower or better scores on the ECOG performance status scale, which assesses how well a patient can take care of themselves in daily living situations.
- Patients had a median of one prior line of CLL therapy.
- Both groups had similar rates of prior chemotherapy (65% vs 64%), but patients in the targeted therapy era had more use of anti-CD20 antibodies and BTK inhibitors.
- The median time from CLL / SLL treatment to the development of Richter transformation was significantly longer in the targeted therapy era (4.9 years) compared with the chemoimmunotherapy era (2.2 years).
- Regardless of the era, those whose CLL / SLL had not been treated before developing Richter transformation had strikingly longer overall survival (OS) compared to those with prior CLL treatment: median OS 42.7 months vs 6.1 months.
- Survival was poor for all patients with Richter transformation, with both groups having an overall survival of less than one year (targeted therapy era: 7 months vs. chemoimmunotherapy era: 11 months).
Conclusions:
In the targeted therapy era, patients are being diagnosed with Richter transformation at older ages and later in their CLL / SLL disease course. However, outcomes for patients with Richter transformation remain poor, with overall survival of less than one year, even with the introduction of targeted therapies. There is a significant unmet need for new, more effective treatment strategies for patients with Richter transformation.
Links and Resources:
Watch the interview on the abstract here:
You can read the actual ASH abstract here: Richter Transformation (RT) in Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL): A Comparison of Two Eras
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