Allogeneic hematopoietic cell transplantation is an effective treatment for patients with Richter syndrome: A systematic review and meta-analysis

Sonikpreet Aulakh, Tea Reljic, Farah Yassine, Ernesto Ayala, Julio C. Chavez, Asher Chanan-Khan, Javier Pinilla-Ibarz, Ambuj Kumar, Mohamed A. Kharfan-Dabaja

Research output: Contribution to journalArticlepeer-review

Abstract

Efficacy of conventional chemoimmunotherapy is limited in patients with Richter syndrome (RS) with anticipated median overall survival (OS) of less than 10 months. Allogeneic hematopoietic cell transplantation (allo-HCT) is commonly offered as a consolidative treatment option in RS. To our knowledge, there are no randomized controlled studies that have compared allo-HCT against other therapies in RS; available allo-HCT data are limited to small case series from single-institution or registry studies. We performed a systematic review and meta-analysis to assess the totality of evidence regarding the efficacy (or lack thereof) of allo-HCT for RS. We extracted data on post-allograft outcomes related to benefits (overall response rate [ORR], complete remission [CR], OS, and progression-free survival [PFS]). For harms, data were extracted on non-relapse mortality (NRM) and relapse post-allografting. Our search strategy identified 240 studies, but only four studies (n = 72 patients) met our inclusion criteria. Pooled ORR, CR, OS, and PFS rates were 79%, 33%, 49%, and 30%, respectively. Pooled NRM and relapse rates were 24% and 28%, respectively. Results of this systematic review and meta-analysis indicate that allo-HCT yields encouraging OS in RS, thus remaining a reasonable treatment option in fit patients whose disease demonstrates a chemosensitive response to pre-transplant salvage therapies. Novel strategies are certainly needed to reduce the risk of relapse to further improve outcomes in these patients.

Original languageEnglish (US)
JournalHematology/ Oncology and Stem Cell Therapy
DOIs
StateAccepted/In press - 2020

Keywords

  • Allogeneic hematopoietic cell transplantation
  • Overall survival
  • Richter syndrome

ASJC Scopus subject areas

  • Hematology
  • Oncology

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