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What Is Richter’s Transformation?

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Published on March 14, 2018

Why should chronic lymphocytic leukemia (CLL) patients be concerned about Richter’s transformation? Noted CLL expert Dr. Stephen Spurgeon from OHSU Knight Cancer Institute explains what it means for CLL treatment, how likely it is to happen, and how to test for it. He also shares what signs to look for, and what kind of patients are more prone to developing Richter’s transformation. Watch now to stay informed about your CLL condition. 

Provided by CLL Global Research Foundation, which received support from AbbVie Inc., Gilead Sciences, TG Therapeutics, Pharmacyclics LLC and Janssen Biotech, Inc., and Genentech. Produced by Patient Power in collaboration with The US Oncology Network, Compass Oncology, and Willamette Valley Cancer Institute and Research Center.

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Transcript | What Is Richter’s Transformation?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hey, Dr. Spurgeon, what is Richter’s transformation? How often does it happen, and why do we worry about it? 

Dr. Spurgeon:     

So Richter’s transformation is essentially going from an indolent disease is the way we think about CLL typically, to a more aggressive transformation to another histology. Richter’s transformation, particularly, we’re talking about transformation to diffuse, large B-cell lymphoma. The longer you have CLL, the more likely you're at risk for having Richter’s transformation. That said, it typically is seen in the relapsed setting after a number of therapies, as again, thinking back to we want the disease to stay as simple as possible. Over time, you get instability of the genetics, or the genome of these cells. As that happens, they're more prone to developing Richter’s transformation. 

There are a lot of nuances and debates about why exactly Richter’s transformation happens. Is it prior therapies? It is virally mediated? What exactly is going on? Sometimes we do see it as the initial presentation. Typically, it’s not a subtle thing, meaning, it’s not well this lymph node has grown slowly over the last few months. It’s typically this lymph node has grown significantly, and I’m having a lot of new symptoms—fatigue, night sweats, things like that. It’s typically not subtle. I think the key factor of Richter’s transformation, why do we care about it? Once it happens, it’s more difficult to treat—especially in people that have been heavily pre-treated. Oftentimes, prognosis with standard chemotherapy is quite poor. There are some promising potential therapies for Richter’s transformation.

I think the other thing to note is that if there's any question, the only way to diagnose it—well, there are a couple things you can do. Well, laboratories can be helpful. Exam can be helpful. A PET scan can be helpful. If you have, I’m often concerned about Richter’s transformation. Maybe I don’t have a real strong sense, but it’s in the back of my mind. A PET scan can be very helpful. A PET scan is a procedure that essentially is a CT scan with radiolabeled sugar that’s administered to you. If you have a more metabolically active tumor, which aggressive tumors are, it’s gonna light up on the scan really, really, what we call, hot, okay? Indolent typical CLL does not light up really, really hot. When someone has Richter’s transformation, you get a PET scan, it may be that area, one area lights up really hot and you're concerned about Richter’s transformation. The others don’t. They look more like CLL.

The only way to officially diagnose a transformation, however, is a tissue biopsy. So, even after I get that PET scan that looks concerning, I go after that hot lymph node to determine what exactly is going on. So, Richter’s transformation is one thing. However, understand that there are other things that lymph node could be, too. I mean, there could be Hodgkin’s lymphoma. There could be an inflammatory reaction. There could be an infection. These are all things that need to be ruled out that we have to do a biopsy. If you're seeing your doctor, and the doctor says, “Well, I know you're sick, but I don't think you’ve got Richter’s transformation,” again, give pause and say, “Well, are you sure we don’t need more workup?” And, or they say, “Oh, you’ve definitely got Richter’s transformation,” but you haven't done a biopsy, that’s where you push back and say, “Well, how do you know? You haven't biopsied me.” 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.