Richter transformation of chronic lymphocytic leukaemia: lines of therapy
4 standard-of-care settings across 4 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | FRα |
|---|---|---|
| Screening, prevention and diagnosis | 1 | · |
| Advanced, first line | 1 | · |
| Third line and beyond | · | 1 |
| Other settings | 1 | · |
Screening, prevention and diagnosis
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Diagnosis | Excision biopsy of the PET-hottest node, histology with clonality studies, TP53 and MYC testing; restage CLL and check for cause such as BTK inhibitor progression. | NCCN Guidelines: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | 92 |
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Diffuse large B-cell type, first treatment | R-CHOP or R-EPOCH chemoimmunotherapy, with venetoclax added in trials; pirtobrutinib or a bispecific antibody in patients unfit for chemotherapy or within trials. | NCCN Guidelines: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | 85 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FRα | Relapsed or chemotherapy-refractory | Clinical trial: bispecific antibodies (epcoritamab, glofitamab), BTK inhibitor with checkpoint inhibitor, CD19 CAR-T, pirtobrutinib; palliative care. | PirtobrutinibAcalabrutinibCAR-T cell therapySafety and Efficacy Study of Epcoritamab in Subjects With Relapsed/Refractory Chronic Lymphocytic Leukemia and Richter's SyndromeACP-196 (Acalabrutinib), a Novel Bruton Tyrosine Kinase (BTK) Inhibitor, for Treatment of Chronic Lymphocytic Leukemia, Richter's Syndrome or Prolymphocytic Leukemia | NCCN Guidelines: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | 89 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Consolidation in responders | Allogeneic stem cell transplant for fit patients with a donor; autologous transplant where chemosensitive and no donor. | NCCN Guidelines: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | 92 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.