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EBMT 2025 | The role of transplantation and CAR-T in the treatment of Richter’s transformation
In this video, Michel van Gelder, MD, PhD, Maastricht University, Maastricht, Netherlands, briefly discusses the role of both allogeneic and autologous stem cell transplantation (SCT) in the treatment of Richter’s transformation. Dr Van Gelder also notes the potential of CAR T-cell therapy in this indication, although comparisons between the outcomes of CAR-T and transplantation are needed. This interview took place at the 51st Annual Meeting of the EBMT in Florence, Italy.
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Transcript
Richter’s transformation is quite a challenge. Many of these patients have rapidly progressive disease. So the first thing is to get them into remission because when they are in remission, then you have a better chance of having any benefit of an allogeneic stem cell transplantation.
On the other side, if you have a patient with Richter’s Transformation in complete remission, there’s even the idea that not allogeneic but autologous transplants could do the job...
Richter’s transformation is quite a challenge. Many of these patients have rapidly progressive disease. So the first thing is to get them into remission because when they are in remission, then you have a better chance of having any benefit of an allogeneic stem cell transplantation.
On the other side, if you have a patient with Richter’s Transformation in complete remission, there’s even the idea that not allogeneic but autologous transplants could do the job. So that’s what is now preferred in these patients with complete remission. But the patients in partial or less than complete remission, then the only chance is allogeneic stem cell transplantation.
Although at the moment CAR T-cell is also available for these patients. And yeah, that comes with less toxicity at a later time point, maybe in the first months there may be some toxicity but most of these patients survive it so that’s also quite an interesting option, of course not in any study compared with allogeneic stem cell transplantation, but yeah, if you have no or fewer longer-term comorbidities or side effects with CAR-T then it may be preferable than doing an allotransplant.
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