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Allogeneic hematopoietic stem-cell transplantation for patients with Richter transformation: a retrospective study on behalf of the Chronic Malignancies Working Party of the EBMT

Bone Marrow Transplantation (2024)Cite this article

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Abstract

Management of Richter transformation (RT) is particularly challenging, with survival estimates <1 year. We report on outcomes of 66 RT patients undergoing allogeneic-HCT (allo-HCT) between 2008 and 2018 registered with the EBMT. Median age at allo-HCT was 56.2 years (interquartile range (IQR), 51.3–63.1). Median time from RT to allo-HCT was 6.9 months (IQR, 4.9–11) and 28 (42.4%) were in complete remission (CR). The majority underwent reduced intensity conditioning (66.2%) using peripheral blood derived stem cells. Eighteen (27.3%) patients had a matched sibling donor, 24 (36.4%) a matched unrelated donor and the remaining were mismatched. Median follow-up was 6.6 years; 1- and 3- year overall and progression free survival (PFS) (95% CI) was 65% (54–77) and 39% (27–51) and 53% (41–65) and 29% (18–40), respectively. Patients in CR at time of allo-HCT had significantly better 3-year PFS (39% vs. 21%, p = 0.032). Cumulative incidences of grade II–IV acute graft versus host disease (GVHD) at day +100 was 41% (95% CI 29–53) and chronic GVHD at 3 years was 53% (95% CI 41–65). High rates of non-relapse mortality (NRM) were observed; 38% (95% CI, 26–50) at 3 years. Although potentially curative, approaches to reduce considerable NRM and chronic GVHD rates are required.

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Fig. 1: Consort diagram of patient disposition.
Fig. 2: Cumulative incidence curves.
Fig. 3: Kaplan–Meier curves.
Fig. 4: Cumulative incidence curves.

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Data availability

The data that support the findings of this study are available on request from the corresponding authors. The data are not publicly available due to privacy or ethical restrictions. No publicly available datasets are available to non-EBMT centres.

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Acknowledgements

All other co-authors contributed data to the study, critically revised the paper and approved the submitted and final version. Medical writing for this manuscript was assisted by MPIYP (MC Béné), Paris, France.

Author information

Authors and Affiliations

  1. CHU Estaing, Clermont-Ferrand University Hospital, Clermont-Ferrand, France

    Romain Guièze & Olivier Tournilhac

  2. EBMT Statistical Unit, Leiden, The Netherlands

    Diderik-Jan Eikema

  3. EBMT Leiden Study Unit, Leiden, The Netherlands

    Linda Koster

  4. University Hospital Dresden, Dresden, Germany

    Johannes Schetelig

  5. Rigshospitalet, Copenhagen, Denmark

    Henrik Sengeloev

  6. University Hospital Basel, Basel, Switzerland

    Jakob Passweg

  7. University of Freiburg, Freiburg, Germany

    Jürgen Finke

  8. Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Istanbul, Turkey

    Mutlu Arat

  9. Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Annoek E. C. Broers

  10. Department of Medicine II, Division for Stem Cell Transplantation and Cellular Immunotherapy, University Hospital Schleswig-Holstein Kiel, Kiel University, Kiel, Germany

    Friedrich Stölzel

  11. Nottingham University, Nottingham, UK

    Jenny Byrne

  12. Gustave Roussy Cancer Campus, Villejuif, France

    Cristina Castilla-Llorente

  13. University of Heidelberg, Heidelberg, Germany

    Peter Dreger

  14. Hannover Medical School, Hannover, Germany

    Matthias Eder

  15. Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Tobias Gedde-Dahl

  16. University Hospital Eppendorf, Hamburg, Germany

    Nicolaus Kröger

  17. ICO-Hospital Universitari Germans Trias i Pujol, Badalona, Spain

    Josep Maria Ribera Santasusana

  18. Southampton General Hospital, Southampton, UK

    Deborah Richardson

  19. ASST Papa Giovanni XXIII, Bergamo, Italy

    Alessandro Rambaldi

  20. Hospital U. Marqués de Valdecilla, Santander, Spain

    Lucrecia Yañez

  21. Maastricht University Medical Center, Maastricht, The Netherlands

    Michel Van Gelder

  22. University Clinical Centre, Medical University of Warsaw, Warsaw, Poland

    Joanna Drozd-Sokolowska

  23. University College London Hospitals NHS Trust London, London, UK

    Kavita Raj & Donal P. McLornan

  24. CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000, Lille, France

    Ibrahim Yakoub-Agha

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  1. Romain Guièze
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Contributions

RG, DJE, OT, IYA, MVG and DM designed the study, analysed data and wrote the manuscript. All other co-authors contributed data to the study, critically revised the paper and approved the submitted and final version.

Corresponding author

Correspondence to Romain Guièze.

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Competing interests

R.G. declares conflicts of interest with Roche, Amgen, Janssen, Abbvie, BeiGene and AstraZeneca.

Ethics approval

This retrospective study was approved by the Chronic Malignancies Working Party (CMWP) of EBMT.

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Guièze, R., Eikema, DJ., Koster, L. et al. Allogeneic hematopoietic stem-cell transplantation for patients with Richter transformation: a retrospective study on behalf of the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02256-9

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