Dr Winter on Unmet Needs in Richter Transformation for Patients With CLL

Allison Winter, MD, Department of Hematology and Medical Oncology, Cleveland Clinic, discusses unmet needs for patients with Richter transformation from chronic lymphocytic leukemia (CLL), highlighting the rationale for conducting a retrospective analysis evaluating real-world outcomes with lisocabtagene maraleucel (liso-cel; Breyanzi) in this patient population.

At the 2024 ASCO Annual Meeting, investigators presented these real-world findings in patients with Richter transformation, which were gathered from the Center for International Blood and Marrow Transplant Research (CIBMTR). The study included 30 patients and found that liso-cel elicited high overall response rates (ORRs) with deep and durable responses and no new safety signals. The median time from CLL diagnosis to Richter transformation was 49 months (range, 0-180), and the median time from Richter transformation to liso-cel infusion was 11 months (range, 1-110). Results showed a 76% ORR (95% CI, 56.5%-89.7%) and a 66% complete response rate (95% CI, 45.7%-82.1%) among evaluable patients, with a median follow-up of 12.3 months (95% CI, 6.1-12.5). The median progression-free survival and overall survival (OS) were not reached (NR; PFS 95% CI, 3.0-NR; OS 95% CI, 10.4-NR), but the estimated 1-year OS rate was 67% (95% CI, 43.6%-82.8%).

Richter transformation is a rare but serious complication that can arise in patients with CLL, occurring in 1% to 10% of cases, depending on the source, Winter begins. There is no established standard of care for this patient population, leading to a significant unmet need due to the poor outcomes, with median OS outcomes ranging from 3 to 12 months, she explains. Effective and durable therapies are urgently needed, Winter reports.

Winter continues by stating that the rationale for this study was to evaluate liso-cel infusion in patients with Richter transformation, she expands. Investigators aimed to specifically assess this population, excluding those with diffuse large B-cell lymphoma not associated with Richter transformation, to gain insights into the effectiveness and safety of this treatment, Winter shares. This multicenter study used real-world data from the CIBMTR, examining the commercial use of liso-cel in patients who received a single infusion and had at least 6 months of follow-up before the data cutoff in February 2023, Winter concludes.