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ESH CLL 2026 | Consensus guidelines for diagnosis, prognosis & clinical trials in Richter’s transformation
Adam Kittai, MD, Icahn School of Medicine at Mount Sinai, New York, NY, discusses the recently published consensus guidelines for the diagnosis, prognosis, and clinical trial development for patients with Richter’s transformation. Dr Kittai highlights the key recommendations, including the preference for excisional biopsy for diagnosis, the avoidance of R-CHOP-like regimens in clinical trials, and the importance of biobanking samples to identify new targeted treatments. This interview took place at the ESH CLL 2026 congress in Stockholm, Sweden.
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Transcript
This year we published our consensus guidelines for the diagnosis and the prognosis and the clinical trial development for patients with Richter’s transformation. What this was was a group of 24 international experts came together and came to a consensus agreement on how we should approach these various topics for Richter’s transformation. The reason why this is important is that Richter’s transformation is a rare disease...
This year we published our consensus guidelines for the diagnosis and the prognosis and the clinical trial development for patients with Richter’s transformation. What this was was a group of 24 international experts came together and came to a consensus agreement on how we should approach these various topics for Richter’s transformation. The reason why this is important is that Richter’s transformation is a rare disease. So you can imagine that in a rare disease, a lot of different investigators and providers treat this disease in various different ways. And so we wanted to get together as a group of physicians who focus on this disease to make some recommendations on how we should approach this disease. And the main things that we discussed out of the 40 consensus statements that we came together were, one, based on diagnosis, we prefer an excisional biopsy, if at all possible, because we need to look at the architecture of the lymph node to diagnose Richter’s transformation. Additionally, we recommend that in further clinical trials, we should try to avoid R-CHOP-like regimens as our standard of care because patients are continuously doing poorly with R-CHOP-like regimens. And last but not least, we should strive to work together to biobank samples and also make progress scientifically to hopefully identify new targeted treatments for patients with Richter’s transformation. One of the other key elements to this consensus statement is we advise on how we should design clinical trials. We focus that we should have our primary endpoints as being based on survival, and we also talk about how each clinical trial should measure response of both the CLL component as well as the diffuse large B-cell lymphoma Richter’s transformation component when reading out results. We hope that by creating these consensus guidelines, we will further allow people to treat Richter’s similarly and hopefully gather data in a more symbiotic method that is better to be evaluated and hopefully make an impact on patient survival overall into the future.
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