Abstract
Management of Richter transformation (RT) is particularly challenging, with survival estimates <1 year. We report on outcomes of 66 RT patients undergoing allogeneic-HCT (allo-HCT) between 2008 and 2018 registered with the EBMT. Median age at allo-HCT was 56.2 years (interquartile range (IQR), 51.3–63.1). Median time from RT to allo-HCT was 6.9 months (IQR, 4.9–11) and 28 (42.4%) were in complete remission (CR). The majority underwent reduced intensity conditioning (66.2%) using peripheral blood derived stem cells. Eighteen (27.3%) patients had a matched sibling donor, 24 (36.4%) a matched unrelated donor and the remaining were mismatched. Median follow-up was 6.6 years; 1- and 3- year overall and progression free survival (PFS) (95% CI) was 65% (54–77) and 39% (27–51) and 53% (41–65) and 29% (18–40), respectively. Patients in CR at time of allo-HCT had significantly better 3-year PFS (39% vs. 21%, p = 0.032). Cumulative incidences of grade II–IV acute graft versus host disease (GVHD) at day +100 was 41% (95% CI 29–53) and chronic GVHD at 3 years was 53% (95% CI 41–65). High rates of non-relapse mortality (NRM) were observed; 38% (95% CI, 26–50) at 3 years. Although potentially curative, approaches to reduce considerable NRM and chronic GVHD rates are required.
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Data availability
The data that support the findings of this study are available on request from the corresponding authors. The data are not publicly available due to privacy or ethical restrictions. No publicly available datasets are available to non-EBMT centres.
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All other co-authors contributed data to the study, critically revised the paper and approved the submitted and final version. Medical writing for this manuscript was assisted by MPIYP (MC Béné), Paris, France.
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RG, DJE, OT, IYA, MVG and DM designed the study, analysed data and wrote the manuscript. All other co-authors contributed data to the study, critically revised the paper and approved the submitted and final version.
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R.G. declares conflicts of interest with Roche, Amgen, Janssen, Abbvie, BeiGene and AstraZeneca.
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This retrospective study was approved by the Chronic Malignancies Working Party (CMWP) of EBMT.
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Guièze, R., Eikema, DJ., Koster, L. et al. Allogeneic hematopoietic stem-cell transplantation for patients with Richter transformation: a retrospective study on behalf of the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02256-9
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DOI: https://doi.org/10.1038/s41409-024-02256-9