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Allogeneic hematopoietic cell transplantation for Richter transformation of chronic lymphocytic leukemia: an intention-to-transplant analysis

Bone Marrow Transplantation volume 58, pages 817–819 (2023)Cite this article

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Richter transformation (RT) to diffuse large B-cell lymphoma (DLBCL) affects approximately 1–3% of patients with chronic lymphocytic leukemia (CLL) [1, 2]. RT is associated with a poor prognosis with standard chemoimmunotherapy with median overall survival (OS) as short as 6–12 months [1,2,3,4,5,6,7]. Consolidation with allogeneic hematopoietic cell transplantation (HCT) is often recommended, particularly for those with high-risk features who have received prior therapy for CLL, do not achieve a complete response to R-CHOP, or have TP53 aberrations or clonally related RT [8]. Registry studies demonstrate durable responses in up to 30–50% of transplanted patients with RT [9, 10]. However, these studies may overestimate the real-world effectiveness of allogeneic HCT for RT due to the selection of younger, medically fit patients with chemo-sensitive disease. An intention-to-transplant (ITT) analysis is therefore valuable to determine the proportion of patients with RT who are considered potentially eligible and actually undergo allogeneic HCT.

This retrospective population-based study was designed to determine the treatment and outcomes of consecutive adult patients with CLL or small lymphocytic lymphoma who developed biopsy-proven DLBCL-type RT in Alberta, Canada, between 2006 and 2020. Patients with Hodgkin-type RT or clinically suspected but not biopsy-confirmed RT were excluded. ITT status was determined via a review of medical records, tumor board notes, and referrals placed to the Alberta Blood and Marrow Transplant Program. Response rates were determined using the Lugano response assessment criteria [11]. OS was measured from the time of RT diagnosis to death from any cause and was estimated using the Kaplan–Meier method. Exploratory analyses were conducted to determine the impact of the International Prognostic Index (IPI) and previous CLL therapy on OS using the log-rank test. Statistical analyses were performed using Prism version 9.4.1 (GraphPad Software, San Diego, California, USA). This study was approved by the Health Research Ethics Board of Alberta. Informed consent was not required for this retrospective study as it posed minimal risk to participants.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Elnair R, Ellithi M, Kallam A, Shostrom V, Bociek RG. Outcomes of Richter’s transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): an analysis of the SEER database. Ann Hematol. 2021;100:2513–9.

    Article  PubMed  Google Scholar 

  2. Al-Sawaf O, Robrecht S, Bahlo J, Fink AM, Cramer P, V Tresckow J, et al. Richter transformation in chronic lymphocytic leukemia (CLL)-a pooled analysis of German CLL Study Group (GCLLSG) front line treatment trials. Leukemia. 2021;35:169–76.

    Article  CAS  PubMed  Google Scholar 

  3. Eyre TA, Clifford R, Bloor A, Boyle L, Roberts C, Cabes M, et al. NCRI phase II study of CHOP in combination with ofatumumab in induction and maintenance in newly diagnosed Richter syndrome. Br J Haematol. 2016;175:43–54.

    Article  CAS  PubMed  Google Scholar 

  4. Langerbeins P, Busch R, Anheier N, Dürig J, Bergmann M, Goebeler ME, et al. Poor efficacy and tolerability of R-CHOP in relapsed/refractory chronic lymphocytic leukemia and Richter transformation. Am J Hematol. 2014;89:E239–43.

    Article  CAS  PubMed  Google Scholar 

  5. Abrisqueta P, Delgado J, Alcoceba M, Oliveira AC, Loscertales J, Hernández-Rivas JA, et al. Clinical outcome and prognostic factors of patients with Richter syndrome: real-world study of the Spanish Chronic Lymphocytic Leukemia Study Group (GELLC). Br J Haematol. 2020;190:854–63.

    Article  CAS  PubMed  Google Scholar 

  6. Tadmor T, Shvidel L, Bairey O, Goldschmidt N, Ruchlemer R, Fineman R, et al. Richter’s transformation to diffuse large B-cell lymphoma: a retrospective study reporting clinical data, outcome, and the benefit of adding rituximab to chemotherapy, from the Israeli CLL Study Group. Am J Hematol. 2014;89:E218–22.

    Article  CAS  PubMed  Google Scholar 

  7. Wang Y, Tschautscher MA, Rabe KG, Call TG, Leis JF, Kenderian SS, et al. Clinical characteristics and outcomes of Richter transformation: experience of 204 patients from a single center. Haematologica. 2020;105:765–73.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Eyre TA, Riches JC, Patten PEM, Walewska R, Marr H, Follows G, et al. Richter transformation of chronic lymphocytic leukaemia: a British Society for Haematology Good Practice Paper. Br J Haematol. 2022;196:864–70.

    Article  PubMed  Google Scholar 

  9. Cwynarski K, van Biezen A, de Wreede L, Stilgenbauer S, Bunjes D, Metzner B, et al. Autologous and allogeneic stem-cell transplantation for transformed chronic lymphocytic leukemia (Richter’s syndrome): a retrospective analysis from the chronic lymphocytic leukemia subcommittee of the chronic leukemia working party and lymphoma working party of the European Group for Blood and Marrow Transplantation. J Clin Oncol. 2012;30:2211–7.

    Article  PubMed  Google Scholar 

  10. Herrera AF, Ahn KW, Litovich C, Chen Y, Assal A, Bashir Q, et al. Autologous and allogeneic hematopoietic cell transplantation for diffuse large B-cell lymphoma-type Richter syndrome. Blood Adv. 2021;5:3528–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32:3059–68.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Parikh SA, Rabe KG, Call TG, Zent CS, Habermann TM, Ding W, et al. Diffuse large B-cell lymphoma (Richter syndrome) in patients with chronic lymphocytic leukaemia (CLL): a cohort study of newly diagnosed patients. Br J Haematol. 2013;162:774–82.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Tom Baker Cancer Centre and University of Calgary, Calgary, AB, Canada

    Robert Puckrin, Carolyn Owen, Douglas Stewart & Mona Shafey

  2. Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada

    Amelie Fontaine & Anthea Peters

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  1. Robert Puckrin
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  2. Carolyn Owen
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  3. Amelie Fontaine
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  4. Anthea Peters
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Contributions

RP designed the study, conducted research, and prepared the manuscript. MS designed the study and prepared the manuscript. CO, AP, AF, and DS prepared the manuscript.

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Correspondence to Robert Puckrin.

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Puckrin, R., Owen, C., Fontaine, A. et al. Allogeneic hematopoietic cell transplantation for Richter transformation of chronic lymphocytic leukemia: an intention-to-transplant analysis. Bone Marrow Transplant 58, 817–819 (2023). https://doi.org/10.1038/s41409-023-01978-6

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