CLL Coverage from Every Angle

Predicting Richter Transformation in Patients With Advanced-Stage CLL

By: Joseph Fanelli
Posted: Friday, December 3, 2021

For patients with advanced-stage chronic lymphocytic leukemia (CLL), rapidly enlarging lymph nodes, unexplained weight loss, elevated lactate dehydrogenase levels, and anemia are among the clinical features associated with Richter transformation, according to findings presented during the 2021 JADPRO Live Virtual Conference (Abstract JL908). (The Journal of the Advanced Practitioner in Oncology [JADPRO] is the host of JADPRO Live, which brings together approximately 1,000 oncology advanced practitioners.) Jacqueline B. Broadway-Duren, PhD, DNP, APRN, FNP-BC, of the MD Anderson Cancer Center at The University of Texas, Houston, outlined the predictive diagnostic factors associated with Richter transformation, the aggressive histologic formation to diffuse large B-cell lymphoma that occurs in 2% to 10% of patients with CLL.

“CLL patients who present with clinical signs of Richter transformation should be evaluated immediately with a PET/CT and possibly biopsy if indicated,” Dr. Broadway-Duren concluded.

Dr. Broadway-Duren highlighted several risk factors physicians should be aware of to promote the early recognition and intervention of Richter transformation. They include advanced Rai stage disease; unmutated IGHV gene, del(17p), TP53, trisomy 12, NOTCH1, and c-MYC; patients with previously treated CLL; germline genetics; and certain aspects of CLL phase biology.

If Richter transformation is suspected, because of bulky nodes, fever, weight loss, among other signs, lab tests for complete blood cell count, comprehensive metabolic panel, next-generation sequencing panel from peripheral blood or bone marrow, IGHV mutation status, cytogenetics, and bone marrow biopsy should be performed.

Additionally, a PET/CT scan should be performed to assess for FDG-avid nodes with a standardized uptake value (SUV) of more than 5. If the SUV value is at least 10 or greater, an excisional node biopsy should be performed to confirm Richter transformation, according to the presenter.

Disclosure: For full disclosures of the study authors, visit

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