Richters Transformation: When a Slow-Growing Cancer Turns Aggressive – SurvivorNet

Dr. Nicole Lamanna Columbia University Medical Center

Chronic lymphocytic leukemia (CLL) is a slow-growing type of cancer. It grows so slowly, in fact, that you can live for many years with your cancer, without having any symptoms or needing treatment. Sometimes, though, CLL can suddenly turn into a more serious condition, a change called Richters transformation.

Richters transformation is a condition in a small subset of CLL patients about 10 to 15% of patients where their disease can transform to a more aggressive lymphoma, Dr. Nicole Lamanna, associate professor of medicine at Columbia University Medical Center, tells SurvivorNet.

CLL often changes into a type of non-Hodgkin lymphoma called diffuse large B-cell lymphoma. Rarely, it turns into a form of Hodgkin lymphoma. If your cancer does change, your doctor will need to put you on a more aggressive treatment to control it.

Doctors dont know exactly why CLL suddenly takes a more serious turn. One theory is that certain people have a few aggressive cancer cells hidden behind their slow-growing ones. Eventually, those cells multiply to the point where they change into a new kind of lymphoma and take over.

How do you know that your cancer has transformed? Theres a big change in their disease, says Dr. Lamanna.

Look for signs like these:

Another important clue is the size of your lymph nodes. They may have a lymph node thats growing out of proportion to whats going on with the rest of their body, Dr. Lamanna says.

Lymph nodes are the little bean-shaped bumps in your neck, armpit, belly, and groin area. Youve likely felt them swollen in your neck at some point when you had an infection. If you notice any unusual swelling in these areas, tell the doctor who treats your cancer about it.

Richters transformation leads to a totally different disease than CLL, and it requires a different kind of treatment. Unlike CLL, which is chronic and we can treat intermittently or over the years, this is something they cant live with, Dr. Lamanna tells SurvivorNet. This is a much more difficult condition to treat.

Doctors usually use the same treatment as they do for large cell lymphoma, she adds. That can be a cocktail of chemotherapy drugs such as R-CHOP the monoclonal antibody rituximab (Rituxan), plus a combination of three chemotherapy drugs and the steroid, prednisone. Or, it can include a different monoclonal antibody called obinutuzumab (Gazyva) plus other combinations of chemo drugs such as EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, hydroxydaunorubicin) or ICE (ifosfamide, carboplatin, etoposide).

Because of the aggressiveness of this disease, some people will ultimately need a stem cell transplant. This treatment starts with high doses of chemotherapy to destroy the cancer cells. Thats followed by an infusion of stem cells immature blood cells either from yourself or a donor. Those cells will grow into healthy new blood cells.

Researchers are studying new combinations of drugs, such as monoclonal antibodies paired with the targeted drug ibrutinib (Imbruvica) or other targeted therapies, to see if they work better against this cancer. This is an area under a lot of investigation. Were looking for new therapies all the time, Dr. Lamanna says.

In the meantime, your situation will determine which treatment your doctor recommends for you. Try to learn as much as you can about your new type of cancer. Dont be afraid to ask questions, including why your doctor is suggesting a specific treatment, how it might help you, and what side effects it could cause. Because this is an aggressive cancer, make sure you have the support you need, whether thats from your family, your medical team, or a lymphoma support group.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Nicole Lamanna is a hematologist/oncologist at Columbia University Medical Center. Her research interests include lymphoid leukemias, specifically chronic lymphocytic leukemia (CLL). Read More