Hodgkin lymphoma transformation in patients with chemotherapy-naïve chronic lymphocytic leukemia

Richter transformation is the development of an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (DLBCL), in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) [ 1 ]. Transformation into Hodgkin lymphoma (HT) is a rare presentation with an incidence of 1 in 200 patients with CLL within 10 years of diagnosis [ 2 ]. Patients with HT have longer survival compared to patients with DLBCL transformation, and the disease is less often clonally related to CLL [ 3 , 4 ]. Standard of care CLL treatment has shifted over the past decade from cytotoxic chemoimmunotherapy to small molecule inhibitors (SMI) targeting Bruton’s tyrosine kinase (BTKi) and B cell leukemia/lymphoma-2 (BCL2i). CLL-directed treatments preceding a diagnosis of HT may result in differences in disease biology, immune function, and, consequently, the clinical course following HT. Here, we report the outcomes in patients with HT in the current CLL therapeutic era.