Dr Winter on the Role of Treatment History in Richter Transformation

“It's really important, when you look at small data sets like this in a small, uncommon event like Richter transformation, to look [closely] at a little more detail of treatment history.”

Allison Winter, MD, a member of the Department of Hematology and Medical Oncology at the Cleveland Clinic, emphasized the importance of considering patients’ treatment history in patients with Richter transformation from chronic lymphocytic leukemia (CLL).

When assessing smaller data sets—notably ones from uncommon events, such as Richter transformation from CLL—it’s essential to carefully evaluate the details of patients’ treatment histories, Winter began.

In a retrospective, observational analysis evaluating real-world patients with Richter transformation from CLL treated with lisocabtagene maraleucel (liso-cel; Breyanzi), evaluable patients (n = 22) achieved an objective response rate (ORR) of 76% (95% CI, 56.5%-89.7%) with complete responses (CRs) achieved in 66% of patients (95% CI, 45.7%-82.1%).

Notably, the FDA approved liso-cel in March 2024 for the treatment of patients with relapsed/refractory CLL or small lymphocytic lymphoma who were previously treated with at least 2 lines of therapy, which included a BTK inhibitor and a BCL-2 inhibitor. The regulatory decision was supported by data from the phase 1/2 TRANSCEND CLL 004 study (NCT03331198).

In the retrospective analysis, 77% of patients in the overall population (n = 30) had received treatment for CLL prior to Richter transformation, and all patients were treated for Richter transformation before they received liso-cel, Winter explained. Furthermore, 83% of patients were refractory to prior BTK inhibitors, and 36% were dual class exposed to a BTK inhibitor and a BCL-2 inhibitor, she noted. Based on the real-world data, Winter emphasized that it’s important to understand the risks before patients receive liso-cel.

The analysis included patients with Richter transformation and evidence of a single infusion with commercially available liso-cel with at least 1 visit after infusion and at least 6 months of follow-up.