Diffuse large B-cell lymphoma (DLBCL) type Richter transformation (DLBCL-RT) in patients with chronic lymphocytic leukaemia (CLL) has a worse prognosis compared to de novo DLBCL (dnDLBCL). We investigated outcomes of patients with DLBCL-RT with or without previous CLL-directed therapy compared to dnDLBCL between 2002 and 2022. We included 6525 patients with dnDLBCL and 383 patients with DLBCL-RT, of whom 260 had Richter transformed treatment-naïve CLL (RT:TN-CLL) and 123 had Richter transformed treatment exposed CLL (RT:TE-CLL). Median time to next treatment or death (TTNTd) was 4.83 years, 1.43 years and 0.46 years for patients with dnDLBCL, RT:TN-CLL and RT:TE-CLL respectively. Median overall survival (OS) following first-line treatment was 9.42, 5.22 and 0.72 years for dnDLBCL, RT:TN-CLL and RT:TE-CLL respectively (p < 0.001). In a high-validity subcohort, OS did not differ significantly between RT:TN-CLL and dnDLBCL (median OS 9.85 years CI: 9.16-10.70 for dnDLBCL, 6.07 years CI: 4.23-not estimable for RT:TN-CLL and 1.15 years CI: 0.76-3.66 for RT:TE-CLL). In conclusion, patients with RT:TE-CLL had inferior TTNTd and OS compared to RT:TN-CLL and dnDLBCL. RT:TN-CLL demonstrated inferior TTNTd compared to dnDLBCL, but OS approached that of dnDLBCL. This indicates that for patients with RT:TN-CLL, chemoimmunotherapy may still be an effective modality, while patients with RT:TE-CLL need novel treatment options.
Katsimigas et al. (Wed,) studied this question.
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