Blood and Lymphatic Cancer: Targets and Therapy (Sep 2021)
Successful Non-Transplant Treatment of Double Hit Richter Transformation with Long-Term Remission
Abstract
Karan Seegobin,1 Muhamad Alhaj Moustafa,1 Liuyan Jiang,2 Han W Tun1 1Department of Hematology and Medical Oncology, Mayo Clinic Hospital, Jacksonville City, FL, 32224, USA; 2Department of Pathology, Mayo Clinic Hospital, Jacksonville City, FL, 32224, USACorrespondence: Karan SeegobinDepartment of Hematology and Medical Oncology, Mayo Clinic Hospital, Jacksonville City, FL, 32224, USAEmail [email protected]: Richter transformation (RT) is defined as the transformation of chronic lymphocytic leukemia (CLL) to a high-grade B cell lymphoma. It usually carries a dismal prognosis and represents an unmet need for novel therapeutic interventions. We report a case of an 80-year-old male who developed double-hit (DH) RT with translocations of MYC and BCL6 after 5 years of watchful waiting for standard-risk CLL. He was treated with induction therapy consisting of 4 cycles of anthracycline-based chemoimmunotherapy (CIT) and 2 cycles of platinum-based CIT with intrathecal methotrexate for CNS prophylaxis followed by continuous maintenance therapy with ibrutinib. He achieved complete remission after the induction therapy. At the time of writing, four and a half years after the diagnosis with DH-RT, he remains in complete remission without evidence of RT or CLL. The novel therapeutic approach used in successful treatment of this patient should be further explored.Keywords: Richter transformation, RT, chronic lymphocytic leukemia, CLL, double hit lymphoma, ibrutinib maintenance
