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Predicting Risk for Richter’s Transformation

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Published on February 7, 2020

Key Takeaways

  • Richter’s transformation is a transformation of B-cell chronic lymphocytic leukemia (CLL) into a fast-growing diffuse large B-cell lymphoma, a variety of non-Hodgkin lymphoma.
  • People with high-risk disease features who have chemotherapy may be at even higher risk for Richter’s.

A panel of chronic lymphocytic leukemia experts including Dr. Farrukh Awan, Dr. Philip Thompson from MD Anderson Cancer Center and Dr. Nicole Lamanna from Columbia University Medical Center discuss Richter’s transformation in chronic lymphocytic leukemia, genetic markers that increase a patient’s disease risk and therapies in development. Watch now to hear their expert perspectives.

This program is sponsored by AbbVie Inc., Genentech, Inc. and Adaptive Biotechnologies. These organizations have no editorial control. It is produced by Patient Power, and Patient Power is solely responsible for program content.

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Transcript | Predicting Risk for Richter’s Transformation

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Audience Member:

With someone like myself who does have horrible markers, and does have a high risk; is there any pretesting you can do to alleviate the bugaboo of Richter's?

Dr. Awan:

So, you know, this is exactly what I—I just joke about it because I like to joke about these—but the cancer doesn’t always read the textbook, I think every cancer has a different biology and we—the numbers we give you are, at the end of the day, approximations. I think we give you averages, that’s all we can do, and as with any average there’s a curve around it; some people will be on this side, some people would be on that said. Can we predict risk of Richter’s? That’s a very, very difficult question; we have certain markers that do increase the risk of having Richter’s; certain mutations on the FISH and on the genetic testing that you’ve had absolutely, comprehensively performed.

So, I think there are definitely certain markers which are predictive of having an increased risk of developing Richter’s, but that doesn’t mean that it’s going to be 100 percent in every single patient. And perfect example, despite all bad markers some people can go a long time without needing treatment, and others might need treatments in six months. So, this is not an exact science, and that’s where the art of medicine comes in; and again, somebody who deals with it on a regular basis might be able to better discern this, and you might get better quality of care.

Dr. Thompson:           

I would say with the prediction of Richter’s that even people who have what we would say high risk, their lifetime risk of developing Richter transformation is probably 10 percent or less. So, it’s something that particularly early in the course of the disease is something that I would encourage most patients not to occupy a lot of their thoughts with. The other thing I would say is that a lot of the data that we have regarding risk of Richter's transformation comes from the chemotherapy era; and probably people with high-risk features in their CLL who have chemotherapy may be at even higher risk. We sort of hope that people with high-risk disease who receive newer therapies as their first treatment will have less a risk of developing it.

Dr. Lamanna:             

But we need to—there’s no doubt that we need to develop better therapies for patients with Richter’s; so that’s an area that all of us are actively working on. 

Dr. Thompson:           

I think they’re coming; actually, I think we’ve got a couple of good therapeutic leads for Richter’s; combination of chemotherapy with venetoclax (Venclexta); some new types of immunotherapies. You know there’s certainly some promise out there that we’re going to be doing better with Richter’s in the future; but I also hope we’ll see less of it as we get better at picking which groups of patients to use which therapy.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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