Emerging Treatment Options for Richter's Transformation
At the 2018 Lymphoma & Myeloma congress held in New York, Richard R. Furman, MD, Director CLL Research Center, Weill Cornell Medicine, New York, New York, spoke to Oncology Learning Network about Richter's transformation and emerging treatment options currently under investigation to try and improve outcomes for these patients.
Transcript
Richter's transformation is a devastating complication for CLL patients, and our therapies really have not gotten much better over the years. We have been using R-EPOCH in place of R-CHOP, but really with no data that the R-EPOCH is any more efficacious than R-CHOP was.
The truth is that most patients who have clonally unrelated will respond to the therapies as any diffuse large b-cell lymphoma patient would, but the patients who have clonally related Richter's still universally do quite poorly. The question, of course, is what can we do to enhance these patients' outcomes?
There are many good ideas currently undergoing, including the idea of using CAR-T cells to consolidate patients after chemotherapy for induction. We also have been adding agents such a lenalidomide, ibrutinib, and Selinexor to try to enhance the patients' responses with an idea that by increasing the sensitivity of the cells to chemotherapy, we might be able to demonstrate or improve the patient's outcomes.
One of the important aspects of the treatment for patients with Richter's is that the bone marrow being so infiltrated with CLL cells makes delivery of chemotherapy problematic. Certainly, having agents that are much more effective and don't have overlapping toxicities, like ibrutinib, idelalisib, acalabrutinib, and dinutuximab, enable us to actually help clear the marrow and possibly enable ourselves to be able to deliver the chemotherapy adequately.
That's a first step. We do need additional agents to really control the Richter's transformation.
