RICHTER'S TRANSFORMATION IN PATIENTS WITH CLL: ANALYSIS OF BIOLOGICAL AND CLINICAL RISK FACTORS AND OUTCOMES

[zevkalman]

A number of abstracts are now available from the EHA meeting last week. One of the papers that caught my eye was an article on Richter's Transformation. The conclusions of the study I quote below, but I am puzzled that they thought it would be instructive to have a graph of Overall Survival of RT patients vs. non-RT patients. I guess that the graph (see above) is pretty depressing for all of us even if you don't get RT, but hopefully all of us are subject to a new set of statistics.

Here's the paper:

RICHTER'S TRANSFORMATION IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (CLL): ANALYSIS OF BIOLOGICAL AND CLINICAL RISK FACTORS AND OUTCOMES

Edwin Gershom* 1, Steven Huang2, Mavis Suhua Ye1, Miriam Ahmed1, Tanya L. Gillan3, Alina S. Gerrie4, Heather A. Leitch5, Cynthia L. Toze4, Khaled M. Ramadan5

1Division of Hematology, St Paul's Hospital, 2Leukemia/BMT Program of BC, Vancouver General Hospital, 3Cytogenetics Laboratory, Vancouver General Hospital and The University of British Columbia, 4Leukemia/BMT Program of BC, Vancouver General Hospital and The University of British Columbia, 5St Paul's Hospital and The University of British Columbia, Vancouver, Canada

and here's the conclusions:

Summary/Conclusion: This study of 59 RT pts is the largest to date analyzing biological and clinical risk factors for outcomes. RT significantly shortened OS compared to CLL control grp. Pts with LDH>1.5ULN, advanced Rai stage, CD38+ and >1 FISH abnormalities at diagnosis should be closely monitored for RT. Early treatment of CLL pts correlating to high risk of RT warrants further investigation. Expanding this study provincially and nationwide, along with a more comprehensive analysis of clinical and biological parameters and their combinations would help in better predicting RT among CLL pts leading to improved patient care.

[Cllcanada Top Poster CURE Hero]

I'm in this study... So far I'm not a tick on the graph.

Depressing sure, and it drives home the fact we need A LOT of research on Richter's... and perhaps better monitoring for high risk CLL including Trisomy 12 earlier on...

[zevkalman in reply to Cllcanada]

Chris, I am really happy that you aren't a tick on that graph. And I hope that you and all of us avoid being ticks on that graph for many, many more years to come.

[DebinOzinLondon]

"Early treatment of CLL pts correlating to high risk of RT warrants further investigation." I wasn't aware of this correlation. Depressing.

[zentangle]

It might be useful to point out that, "ABSTRACT: Richter's transformation, or Richter's syndrome, is an uncommon clinicopathological condition observed in about 5% to 10% of patients with chronic lymphocytic leukemia (CLL). " Susan o'Brien "Cancer Network" 2012.

[PaulaS Volunteer]

If Richters affects 5% to 10% of patients with CLL, it's not really "uncommon". And I think the odds go up the longer we live... I really hope more research will be done re treatments for it...

[zevkalman in reply to PaulaS]

If someone happens to be in that 5% - 10% of patients, it doesn't matter how uncommon it is to the other 90%. I know a woman who just died from RT a month or two ago. Not fun.

[AussieNeil Administrator in reply to PaulaS]

My thoughts exactly Paula. Between a 1 in 20 and 1 in 6 chance is definitely not "uncommon". I've read up to 15% risk elsewhere and the risk is likely to worsen as CLL treatments improve and extend survival times. If we faced that level of risk in other circumstances and it was avoidable, I'm sure that level of risk would change our behaviour. So let's hope that researchers see the opportunity to invest in research that could provide a huge return in extended lifetimes for those of us that do develop Richters...

[zentangle]

My post was in response to Debinmelbourne's comment about the situation being "depressing". I was going to put a caveat on my post about obviously being concerned about people who have had Richter's (of which I may become one), but did not, at the time, feel it to be necessary. The study which I took the quote from says that the figure is between 2 and 10% and quotes "about" 500 people in the USA. The purpose of such figures was to contextualise the original post, which had not been contextualised and may have been a little alarming for someone who was unsure what percentage of cases are prone to transformation.

[DebinOzinLondon]

Thanks for the reassurance Zentangle and all. There is a higher risk for of RT for those of us with the SLL presentation of the disease. That and the fact I was treated with FCR within a year of diagnosis and will hopefully live with CLL for a long time makes me believe the odds are stacked against me. I'm having Notch and BIRC testing done to try to help the decision as to whether to enter a BTK inhibitor trial soon or head to transplant. I feel like my life is one big risk assessment at the moment!

[zentangle]

Hi Deb, where did you hear that SLL patients have higher chance of RT?