Clinical characteristics and outcomes of Richter transformation: Experience of 204 patients from a single center

Yucai Wang; Marcella A. Tschautscher; Kari G. Rabe; Timothy G. Call; Jose F. Leis; Saad S. Kenderian; Neil E. Kay; Eli Muchtar; Daniel L. van Dyke; Amber B. Koehler; Susan M. Schwager; Susan L. Slager; Sameer A. Parikh; Wei Ding

doi:10.3324/haematol.2019.224121

Clinical characteristics and outcomes of Richter transformation: Experience of 204 patients from a single center

Yucai Wang, Marcella A. Tschautscher, Kari G. Rabe, Timothy G. Call, Jose F. Leis, Saad S. Kenderian, Neil E. Kay, Eli Muchtar, Daniel L. van Dyke, Amber B. Koehler, Susan M. Schwager, Susan L. Slager, Sameer A. Parikh, Wei Ding

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Abstract

The natural history, prognostication and optimal treatment of Richter transformation developed from chronic lymphocytic leukemia (CLL) are not well defined. We report the clinical characteristics and outcomes of a large series of biopsy-confirmed Richter transformation (diffuse large B-cell lymphoma or high grade B-cell lymphoma, n=204) cases diagnosed from 1993 to 2018. After a median follow up of 67.0 months, the median overall survival (OS) was 12.0 months. Patients who received no prior treatment for CLL had significantly better OS (median 46.3 vs. 7.8 months; P<0.001). Patients with elevated lactate dehydrogenase (median 6.2 vs. 39.9 months; P<0.0001) or TP53 disruption (median 8.3 vs. 12.8 months; P=0.046) had worse OS than those without. Immunoglobulin heavy chain variable region gene mutation, cell of origin, Myc/Bcl-2 double expression and MYC/BCL2/BCL6 double-/triple-hit status were not associated with OS. In multivariable Cox regression, elevated lactate dehydrogenase [Hazard ratio (HR) 2.3, 95% Confidence Interval (CI): 1.3-4.1; P=0.01], prior CLL treatment (HR 2.0, 95%CI: 1.2-3.5; P=0.01), and older age (HR 1.03, 95%CI: 1.01-1.05; P=0.01) were associated with worse OS. Twentyfour (12%) patients underwent stem cell transplant (20 autologous and 4 allogeneic), and had a median post-transplant survival of 55.4 months. In conclusion, the overall outcome of Richter transformation is poor. Richter transformation developed in patients with untreated CLL has significantly better survival. Stem cell transplant may benefit select patients.

Original language	English (US)
Pages (from-to)	765-773
Number of pages	9
Journal	Haematologica
Volume	105
Issue number	3
DOIs	https://doi.org/10.3324/haematol.2019.224121
State	Published - Mar 1 2020

ASJC Scopus subject areas

Hematology

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Wang, Y., Tschautscher, M. A., Rabe, K. G., Call, T. G., Leis, J. F., Kenderian, S. S., Kay, N. E., Muchtar, E., van Dyke, D. L., Koehler, A. B., Schwager, S. M., Slager, S. L., Parikh, S. A., & Ding, W. (2020). Clinical characteristics and outcomes of Richter transformation: Experience of 204 patients from a single center. Haematologica, 105(3), 765-773. https://doi.org/10.3324/haematol.2019.224121

Wang, Y, Tschautscher, MA, Rabe, KG, Call, TG, Leis, JF, Kenderian, SS , Kay, NE, Muchtar, E, van Dyke, DL, Koehler, AB, Schwager, SM, Slager, SL , Parikh, SA & Ding, W 2020, 'Clinical characteristics and outcomes of Richter transformation: Experience of 204 patients from a single center', Haematologica, vol. 105, no. 3, pp. 765-773. https://doi.org/10.3324/haematol.2019.224121

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title = "Clinical characteristics and outcomes of Richter transformation: Experience of 204 patients from a single center",

abstract = "The natural history, prognostication and optimal treatment of Richter transformation developed from chronic lymphocytic leukemia (CLL) are not well defined. We report the clinical characteristics and outcomes of a large series of biopsy-confirmed Richter transformation (diffuse large B-cell lymphoma or high grade B-cell lymphoma, n=204) cases diagnosed from 1993 to 2018. After a median follow up of 67.0 months, the median overall survival (OS) was 12.0 months. Patients who received no prior treatment for CLL had significantly better OS (median 46.3 vs. 7.8 months; P<0.001). Patients with elevated lactate dehydrogenase (median 6.2 vs. 39.9 months; P<0.0001) or TP53 disruption (median 8.3 vs. 12.8 months; P=0.046) had worse OS than those without. Immunoglobulin heavy chain variable region gene mutation, cell of origin, Myc/Bcl-2 double expression and MYC/BCL2/BCL6 double-/triple-hit status were not associated with OS. In multivariable Cox regression, elevated lactate dehydrogenase [Hazard ratio (HR) 2.3, 95% Confidence Interval (CI): 1.3-4.1; P=0.01], prior CLL treatment (HR 2.0, 95%CI: 1.2-3.5; P=0.01), and older age (HR 1.03, 95%CI: 1.01-1.05; P=0.01) were associated with worse OS. Twentyfour (12%) patients underwent stem cell transplant (20 autologous and 4 allogeneic), and had a median post-transplant survival of 55.4 months. In conclusion, the overall outcome of Richter transformation is poor. Richter transformation developed in patients with untreated CLL has significantly better survival. Stem cell transplant may benefit select patients.",

author = "Yucai Wang and Tschautscher, {Marcella A.} and Rabe, {Kari G.} and Call, {Timothy G.} and Leis, {Jose F.} and Kenderian, {Saad S.} and Kay, {Neil E.} and Eli Muchtar and {van Dyke}, {Daniel L.} and Koehler, {Amber B.} and Schwager, {Susan M.} and Slager, {Susan L.} and Parikh, {Sameer A.} and Wei Ding",

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year = "2020",

month = mar,

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doi = "10.3324/haematol.2019.224121",

language = "English (US)",

volume = "105",

pages = "765--773",

journal = "Haematologica",

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T1 - Clinical characteristics and outcomes of Richter transformation

T2 - Experience of 204 patients from a single center

AU - Wang, Yucai

AU - Tschautscher, Marcella A.

AU - Rabe, Kari G.

AU - Call, Timothy G.

AU - Leis, Jose F.

AU - Kenderian, Saad S.

AU - Kay, Neil E.

AU - Muchtar, Eli

AU - van Dyke, Daniel L.

AU - Koehler, Amber B.

AU - Schwager, Susan M.

AU - Slager, Susan L.

AU - Parikh, Sameer A.

AU - Ding, Wei

PY - 2020/3/1

Y1 - 2020/3/1

N2 - The natural history, prognostication and optimal treatment of Richter transformation developed from chronic lymphocytic leukemia (CLL) are not well defined. We report the clinical characteristics and outcomes of a large series of biopsy-confirmed Richter transformation (diffuse large B-cell lymphoma or high grade B-cell lymphoma, n=204) cases diagnosed from 1993 to 2018. After a median follow up of 67.0 months, the median overall survival (OS) was 12.0 months. Patients who received no prior treatment for CLL had significantly better OS (median 46.3 vs. 7.8 months; P<0.001). Patients with elevated lactate dehydrogenase (median 6.2 vs. 39.9 months; P<0.0001) or TP53 disruption (median 8.3 vs. 12.8 months; P=0.046) had worse OS than those without. Immunoglobulin heavy chain variable region gene mutation, cell of origin, Myc/Bcl-2 double expression and MYC/BCL2/BCL6 double-/triple-hit status were not associated with OS. In multivariable Cox regression, elevated lactate dehydrogenase [Hazard ratio (HR) 2.3, 95% Confidence Interval (CI): 1.3-4.1; P=0.01], prior CLL treatment (HR 2.0, 95%CI: 1.2-3.5; P=0.01), and older age (HR 1.03, 95%CI: 1.01-1.05; P=0.01) were associated with worse OS. Twentyfour (12%) patients underwent stem cell transplant (20 autologous and 4 allogeneic), and had a median post-transplant survival of 55.4 months. In conclusion, the overall outcome of Richter transformation is poor. Richter transformation developed in patients with untreated CLL has significantly better survival. Stem cell transplant may benefit select patients.

AB - The natural history, prognostication and optimal treatment of Richter transformation developed from chronic lymphocytic leukemia (CLL) are not well defined. We report the clinical characteristics and outcomes of a large series of biopsy-confirmed Richter transformation (diffuse large B-cell lymphoma or high grade B-cell lymphoma, n=204) cases diagnosed from 1993 to 2018. After a median follow up of 67.0 months, the median overall survival (OS) was 12.0 months. Patients who received no prior treatment for CLL had significantly better OS (median 46.3 vs. 7.8 months; P<0.001). Patients with elevated lactate dehydrogenase (median 6.2 vs. 39.9 months; P<0.0001) or TP53 disruption (median 8.3 vs. 12.8 months; P=0.046) had worse OS than those without. Immunoglobulin heavy chain variable region gene mutation, cell of origin, Myc/Bcl-2 double expression and MYC/BCL2/BCL6 double-/triple-hit status were not associated with OS. In multivariable Cox regression, elevated lactate dehydrogenase [Hazard ratio (HR) 2.3, 95% Confidence Interval (CI): 1.3-4.1; P=0.01], prior CLL treatment (HR 2.0, 95%CI: 1.2-3.5; P=0.01), and older age (HR 1.03, 95%CI: 1.01-1.05; P=0.01) were associated with worse OS. Twentyfour (12%) patients underwent stem cell transplant (20 autologous and 4 allogeneic), and had a median post-transplant survival of 55.4 months. In conclusion, the overall outcome of Richter transformation is poor. Richter transformation developed in patients with untreated CLL has significantly better survival. Stem cell transplant may benefit select patients.

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Clinical characteristics and outcomes of Richter transformation: Experience of 204 patients from a single center

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