iwCLL 2025 | Real-world experience using venetoclax plus chemotherapy in patients with Richter’s transformation

I collected data about our Italian experience about the use of venetoclax plus chemotherapy in this difficult kind of patient that are patients with Richter’s transformation. We know that Richter’s transformation is the development of an aggressive disease in patients with CLL or chronic lymphocytic leukemia or small lymphocytic lymphoma. And we also know that Richter’s transformation nowadays is a met clinical need because these patients have a poor prognosis and a median survival of less than 12 months with standard chemoimmunotherapy. So we really need to improve the survival for these patients and in the last years this combination of venetoclax plus chemotherapy have proved very good results, also in retrospective and prospective clinical trials. And based on this assumption I decided to collect also our experience about the use of this combination in Italy, and the responses are the same as the retrospective and prospective analysis. So I think our little experience is in line with the analyses that have used this combination. 

We recorded the side effects of course because also chemotherapy alone can determine some side effects. So if we combine another agent, of course, we have the possibility to develop side effects. The main side effects were hematological. In particular, we recorded high hematological toxicity in terms of neutropenia, grade 3 & 4 neutropenia, and also anemia and thrombocytopenia, but it was attended. and on the other side, this led to a high risk of infection. So we know that there is the possibility to reduce this toxicity because we can use the combination Venetoclax plus R-CHOP rather than Venetoclax with R-DA-EPOCH because probably the effectiveness is the same but with a better toxicity profile with the combination Venetoclax plus R-CHOP. So as I reported in my presentation it’s important to select patients really suitable for this treatment and to manage these patients with antibacterial prophylaxis and to evaluate the ECOG status before the treatment.

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