Posted: Thursday, June 23, 2022
Maryam Alasfour MD, of the University of Miami Sylvester Cancer Center, and colleagues conducted a study to learn more about Richter’s syndrome in patients with chronic lymphocytic leukemia (CLL) who were treated with platinum- or anthracycline-based chemotherapy with or without a Bruton’s tyrosine kinase (BTK) inhibitor. Presented during the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract e19511), the retrospective study findings suggested that although the median overall survival is similar with anthracycline- and platinum-based chemotherapy, platinum-based chemotherapy may lead to better complete response and progression-free survival.
“Patients who develop Richter’s syndrome often have high-risk CLL, especially complex cytogenetics,” stated the study authors. “Although a large proportion of patients with Richter’s syndrome respond to front-line therapy, almost half relapse.”
The data on 33 patients with CLL who were diagnosed at the University of Miami Sylvester Cancer Center between 2011 and 2020 with pathologically confirmed Richter’s syndrome were retrospectively reviewed. Institutional review board–approved protocols were used to provide informed consent, and overall survival was calculated from Richter’s syndrome diagnosis to death or last follow-up.
The median time from CLL diagnosis to Richter’s syndrome development was 37 months. The majority of patients presented with a complex karyotype (81%), elevated lactate dehydrogenase levels (75%), bulky lymphadenopathy (66%), and TP53 disruption (52%). Fluorescence in situ hybridization detected trisomy 12 (58%), as well as deletions of 17p (37%) and 11q (17%). Despite a 75.8% objective response rate, 44% of those who achieved a complete response eventually relapsed.
Among patients on anthracycline-based chemotherapy, the median progression-free survival was 10 months; the median survival for those on platinum-based chemotherapy was 15.5 months. Irrespective of the type of chemotherapy, similar median overall survival was observed for both anthracycline- and platinum-based regimens (60 and 59.5 months). Of note, median overall survival of more than 10 years was observed when combining a BTK inhibitor with chemotherapy in patients who had not received prior BTK inhibitors.
Disclosure: The study authors reported no conflicts of interest.