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Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Thursday, July 28, 2022
A review article published in Frontiers in Oncology discusses the current literature surrounding treatment options for patients with high-risk chronic lymphocytic leukemia (CLL) and Richter syndrome. Toby Andrew Eyre, MBChB, MD, of the Oxford Cancer and Haematology Centre, United Kingdom, and his colleagues highlighted how allogeneic stem cell transplantation (SCT) and chimeric antigen receptor (CAR) T-cell therapy play a role in treating these diseases.
Most patients with CLL will be treated with venetoclax-based therapy and continuous covalent Bruton’s tyrosine kinase (BTK) inhibition with or without anti-CD20 therapy. Other therapies that have been tested in high-risk CLL cohorts include phosphoinositide 3-kinase inhibitors and non-covalent BTK inhibitors.
Allogeneic SCT has historically been used only for patients with very high–risk CLL due to the significant amount of hazards associated with this treatment, and its exact role in CLL therapy has not yet been defined. However, more recently, allogeneic SCT has shown to be effective and safe for patients with high-risk CLL after exposure to a targeted inhibitor. Multiple studies have shown a durable graft-versus-leukemia effect of allogeneic SCT among this cohort.
For patients who have chemosensitive Richter syndrome, allogeneic SCT seems to be a viable treatment option. The overall survival rates for patients with this disease who are treated with SCT ranges from 36% to 49%, according to a number of different studies. There is still a void of information regarding the source of stem cells, conditioning regimens, and prophylaxis for graft-versus-host disease for these patients.
Data on CAR T-cell therapy for Richter syndrome are limited and conflicting to date, and existing studies have enrolled small numbers of patients. There are disease responses noted for a minority of patients enrolled in these studies, highlighting the potential of CAR T-cell therapy for high-risk patients with few therapeutic options.
Disclosure: For a full list of authors’ disclosures, visit frontiersin.org.
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