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Chronic lymphocytic leukemia

Richter transformation in chronic lymphocytic leukemia (CLL)—a pooled analysis of German CLL Study Group (GCLLSG) front line treatment trials

Leukemia volume 35, pages 169–176 (2021)Cite this article

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Abstract

Richter transformation (RT) is defined as development of aggressive lymphoma in patients (pts) with CLL. The incidence rates of RT among pts with CLL range from 2 to 10%. The aim of this analysis is to report the frequency, characteristics and outcomes of pts with RT enrolled in trials of the GCLLSG. A total of 2975 pts with advanced CLL were reviewed for incidence of RT. Clinical, laboratory, and genetic data were pooled. Time-to-event data, starting from time of CLL diagnosis, of first-line therapy or of RT diagnosis, were analyzed by Kaplan-Meier methodology. One hundred and three pts developed RT (3%): 95 pts diffuse large B-cell lymphoma (92%) and eight pts Hodgkin lymphoma (8%). Median observation time was 53 months (interquartile range 38.1–69.5). Median OS from initial CLL diagnosis for pts without RT was 167 months vs 71 months for pts with RT (HR 2.64, CI 2.09–3.33). Median OS after diagnosis of RT was 9 months. Forty-seven pts (46%) received CHOP-like regimens for RT treatment. Three pts subsequently underwent allogeneic and two pts autologous stem cell transplantation. Our findings show that within a large cohort of GCLLSG trial participants, 3% of the pts developed RT after receiving first-line chemo- or chemoimmunotherapy. This dataset confirms the ongoing poor prognosis and high mortality associated with RT.

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Fig. 1: Time to RT from first-line CLL treatment.
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Acknowledgements

We thank the patients and their families for the trust and confidence they have placed in us as well as all participating sites for their active contributions to our studies. OA, SR, JB, BE designed the study, analysed the data and wrote the manuscript. AMF, PC, JvT, EL, MK, MD, MR, JD, ET, SS, CMW, VG and MH revised and discussed the data and reviewed the manuscript. ET and StSt were supported by the DFG (SFB1074, subprojects B1 and B2).

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Authors and Affiliations

  1. Department I of Internal Medicine and Center of Integrated Oncology Aachen, University of Cologne, Bonn, Cologne, Duesseldorf, Cologne, Germany

    O. Al-Sawaf, S. Robrecht, J. Bahlo, A. M. Fink, P. Cramer, J. v Tresckow, K. Fischer,  Goede V, M. Hallek & B. Eichhorst

  2. Department of Hematology and Oncology, Evangelisches Krankenhaus Hamm, Hamm, Germany

    E. Lange

  3. Department of Internal Medicine, Frankfurt (Oder) General Hospital, Frankfurt/Oder, Germany

    M. Kiehl

  4. Department of Medicine III, University Hospital Ludwig Maximilians University, Munich, Germany

    M. Dreyling

  5. Second Medical Department, University Hospital Schleswig-Holstein, Kiel, Germany

    M. Ritgen

  6. Department of Hematology, University Hospital Essen, Essen, Germany

    J. Dürig

  7. Department of Internal Medicine III, Ulm University, Ulm, Germany

    E. Tausch, C. Schneider & S. Stilgenbauer

  8. Department of Internal Medicine I, Saarland University Medical Center, Homburg, Germany

    S. Stilgenbauer

  9. Department of Hematology, Oncology, Immunology, Palliative Care, Infectious Diseases and Tropical Medicine, German CLL Study Group, Munich Clinic Schwabing, Munich, Germany

    C. M. Wendtner

  10. Oncogeriatric Unit, Department of Geriatric Medicine, St. Marienhospital, Cologne, Germany

    Goede V

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  1. O. Al-Sawaf
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Correspondence to O. Al-Sawaf or B. Eichhorst.

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OA reports personal fees and non-financial support from AbbVie, Roche, Gilead, Janssen. JB reports personal fees and non-financial support from Roche. PC reports personal fees and non-financial support from Roche, Janssen, Astellas, Gilead, Mundipharma, Novartis. JD reports personal fees and non-financial support from Celgene, Janssen and Abbvie. BE reports grants and personal fees from Roche, AbbVie, Gilead, Janssen. AMF reports personal fees from Janssen Pharmaceutical. KF reports non-financial support and personal fees from Roche and Abbvie. VG reports personal fees and non-financial support from Roche, Gilead, Janssen. MH reports personal fees and non-financial support from AbbVie, Roche, Gilead, Janssen, personal fees from Celgene, Boehringer Ingelheim. MR reports grants and personal fees from Roche/AbbVie. StSt reports grants, personal fees and non-financial support from AbbVie, Roche; grants, personal fees and non-financial support from Amgen, AstraZeneca, Celgene, Gilead, GSK, Janssen, Novartis, Pharmacyclics, Sunesis. ET reports personal fees from Roche, AbbVie. CMW reports grants and/or personal fees from Hoffmann-La Roche, Mundipharma, Servier; Janssen-Cilag, Novartis, Gilead, Morphosys and Abbvie. All others declare no conflict of interest.

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Al-Sawaf, O., Robrecht, S., Bahlo, J. et al. Richter transformation in chronic lymphocytic leukemia (CLL)—a pooled analysis of German CLL Study Group (GCLLSG) front line treatment trials. Leukemia 35, 169–176 (2021). https://doi.org/10.1038/s41375-020-0797-x

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