Re: Richters Transformation, what besides R-CHOP?

[Guest guest]

At least half of Richter's transformations have a del 17

p/TP53 problem and CHOP-R makes no sense. High dose steroids

with rituximab is a more logical choice

Terry Hamblin MD

In a message dated 10/06/2011 Marilyn Barbera writes:

Am to see a heme/onc Monday to schedule biopsy of Lymph node

and bone marrow to confirm. R-CHOP seems to be the standard

chemo treatment. Is there any other additional options

after R-CHOP such as BMT or stem cell transplant? Am in good

health otherwise, but age 75 may be a factor.

Statistics are depressing, less than a year survival. May

not opt for R-CHOP, and have a better quality of life for a

shorter period. Can anyone help me to weigh the advantages

and disadvantages of treatment?

[Guest guest]

Dr. Hamblin:

Does Hyper CVAD make any more sense than R-CHOP for folks

with del 17 type of Richter's transformation?

Thanks,

Larry

>

> At least half of Richter's transformations have a del 17

> p/TP53 problem and CHOP-R makes no sense. High dose steroids

> with rituximab is a more logical choice

>

> Terry Hamblin MD

[Guest guest]

It is more toxic and I believe that there was an MD

trial of it that was unsuccessful, but this is just off the

top of my head without researching it.

In a message dated 11/06/2011 Larry wrote:

>

> Does Hyper CVAD make any more sense than R-CHOP for folks

> with del 17 type of Richter's transformation?

Dr. Hamblin wrote:

>

> At least half of Richter's transformations have a del 17

> p/TP53 problem and CHOP-R makes no sense. High dose steroids

> with rituximab is a more logical choice.

[Guest guest]

Dear Marilyn,

I would consult one or more CLL experts about trials and

novel off-protocol therapies - a customized protocol that

can combine standard and investigational agents.

There are few studies recruiting for Richter's

transformation ... for example one combines the btk

inihibitor (PCI-32765) with ofatumumab ...

See http://1.usa.gov/m8EOke you can then click Results on

Map to findstudies near you. You might also call the

investigator in the contact section of the protocol for more

leads.

All the best,

Karl

>

> Am to see a heme/onc Monday to schedule biopsy of Lymph node

> and bone marrow to confirm. R-CHOP seems to be the standard

> chemo treatment. Is there any other additional options

> after R-CHOP such as BMT or stem cell transplant? Am in good

> health otherwise, but age 75 may be a factor.

>

> Statistics are depressing, less than a year survival. May

> not opt for R-CHOP, and have a better quality of life for a

> shorter period. Can anyone help me to weigh the advantages

> and disadvantages of treatment?

[Guest guest]

Marilyn

Most of the research on Richter's is scant or old. You need

to determine if it is a true transformation or a parallel

lymphoma and your TP53 gene situation. This should be done

by a CLL expert, IMHO.

The question you should be asking is it clonally related to

the CLL.

In a recent study from Italy, unrelated cases had a longer

median survival (62.5 months) compared to clonally related

cases (14.2 months)

Knowing this will guide the use of treatment either to

R-CHOP or perhaps to Rituxan and pulsed high dose

methylprednisolone (R-HDMP) or a clincal trial.

Important reference:

" The genetics of Richter syndrome reveals disease

heterogeneity and predicts survival post-transformation "

Here are other recent PPV articles:

http://informahealthcare.com/doi/abs/10.3109/10428190903515192

http://jco.ascopubs.org/content/29/10/e274.long

Time is of the essence...

~chris

[Guest guest]

I had Richters Transformation from CLL/SLL in 2006. Sorry

but I can't be more specific right now about the type of

Richters. I had a Stem Cell transplant in Aug of 2006 and

am doing fine. The transplant was at Karmanos Cancer Center

in Detroit. Dr. Schiffer is an excellant blood cancer

Oncologist. He contacted a Richters specialist and things

went very well. The transplant team is also excellant

expecially Dr. Uberti and Dr Vorivit Ratanatharathorn.

I'm pretty sure I had CHOP and ICE but neither worked. If

you need me to be more specific I can go thru my records.

Let me know.

[Guest guest]

lin - results can be much better -

In a message dated 6/10/2011 Marilyn Barbera writes:

Statistics are depressing, less than a year survival.

[Guest guest]

Marilyn - is right. I know of a couple of people who

did very well with treatment and are out living their lives,

so they don't come here often.

Pat

[Guest guest]

:

I went to another heme/onc who agreed it was premature to

diagnose Richters on the basis of the PET scan alone.. He is

planning a lymph node and bone marrow biopsy. It may be Cll

back again. If Cll, he talked about Treanda. One of Dr.

Furman's past messages had a list of possible treatments for

relapse including CT's of CAL 101 and PCI 32765. Will go to

gov clinical trials on the web.

Thanks to all who replied.

Marilyn

[Guest guest]

Good to hear you have another doctor..

Usually a very elevated level of LDH is an indicator of

Richter's as I understand it... gallium or PET scans are

used to locate a biopsy site.

Here is a page by Cancer Care Options, CCO - Dr. Keating,

Vose and Levine discuss Richter's diagnosis...the use of

OFAR and HSCTs (Free Registration Required):

http://tinyurl.com/6kgq9b6

~chris

CLL CANADA

http://cllcanada.ca