Richter Transformation in the Canadian Landscape: Clinical Perspectives and Emerging Trends

Over the past decade, the treatment landscape for chronic lymphocytic leukemia (CLL) and its lymphoma counterpart, small lymphocytic lymphoma (SLL), has evolved significantly. The shift from chemoimmunotherapy (CIT) to the increased use of targeted agents, such as Bruton’s tyrosine kinase inhibitors (BTKi) and B-cell lymphoma 2 inhibitors (BCL2i), has led to marked improvements in patient outcomes. Despite these advancements, some patients still experience disease transformation to a more aggressive histology known as Richter Transformation (RT), and the clinical outcomes with this histology remain dismal, with median overall survival (OS) typically shorter than one year. Therefore, RT represents a significant unmet need for patients with CLL/SLL. This review describes recent advances in the understanding and management of RT within the Canadian landscape, focusing on transformation to diffuse large B-cell lymphoma (DLBCL).