Romain Guieze, Thomas Remen, Julien Broséus, Catherine Thieblemont, Stephan Stilgenbauer, Sandra Lomazzi, Eugen Tausch, Florian Bouclet, Hélène Busby, Kamel Laribi, Veronique Leblond, Marie C. Béné, Florence Cymbalista, Caroline Dartigeas, Sébastien Hergalant, Cécile Tomowiak, Romain Morizot, Hélène Augé, Charline Moulin, Francis Guillemin, Anne Quinquenel, Pierre Feugier, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Service d'Hématologie [CHRU Nancy], Service d'hématologie [Reims], Hôpital Robert Debré, Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims)-Hôpital Robert Debré-Centre Hospitalier Universitaire de Reims (CHU Reims), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de Pathologie [CHRU Nancy], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Universität Ulm - Ulm University [Ulm, Allemagne], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Avicenne [AP-HP], Centre Hospitalier Le Mans (CH Le Mans), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), and Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)
Richter Syndrome (RS) corresponds to the transformation of Chronic Lymphocytic Leukemia (CLL) or Small Lymphocytic Lymphoma (SLL) into an aggressive lymphoma, in most cases a Diffuse Large B-Cell Lymphoma (DLBCL). RS outcome is variable and still poorly understood. The aim of our study was to analyze the clinical, biological and molecular features liable to predict survival in a retrospective series of newly diagnosed RS from the French Innovative Leukemia Organization (FILO). From 10 French centers, 103 biopsy-confirmed DLBCL subtype RS, diagnosed from 2001 to 2019, were identified. Fresh-frozen biopsies (FB) were available in 58 cases. All biopsies were centrally reviewed. Clinical and biological characteristics at CLL and RS diagnoses including cytogenetics, clonal relationship with the pre-existing CLL, Epstein-Barr virus (EBV) status, cell of origin (COO) according to the Hans algorithm, RS prognostic scores (Tsimberidou et al. J Clin Oncol. 2006, Rossi et al. Blood 2011) as well as treatment and outcomes were collected. Targeted next generation sequencing was used on RS FB for the following gene set: TP53, ATM, SF3B1, NOTCH1, BIRC3, FBXW7, RPS15, EGR2, MYD88, XPO1, POT1, BRAF, and NFKBIE. Overall Survival (OS) was defined as time from RS diagnosis until the date of death or end of follow-up and analyzed using Kaplan-Meier method. Multivariable analysis was performed using Cox regression model for variables with a p-value Clinical and biological characteristics and outcomes were broadly similar between the full 103-patient cohort and the subset of 58 patients with available gene mutation data. The latter only was considered for the subsequent analyses. The median age at CLL/SLL diagnosis was 60 (range 34-81) and 39 patients (67.2%) were male. Prior to RS, 24 (41.38%) received more than 1 line of treatment for CLL. The median time to transformation was 5 years (range 0-22). The median OS from RS diagnosis was 8 months (Figure 1a). The median age at RS diagnosis was 65.5 years (range 42-87). ECOG Performance Status (PS) was >1 in 29/53 patients (54.8%) and 32/56 (57.1%) had a Bulky disease. Elevated Lactate DeHydrogenase (LDH) levels (≥ 1.5N) were found in 38/49 patients (77.6%). Unmutated IGHV was observed in 45/58 (77.6%) RS samples. CLL and RS were clonally related for 29/33 (87.9%) RS with available IGHV sequence at CLL diagnosis. TP53 disruption was detected in 34/56 (60.7%) RS cases including TP53 mutations in 23/58 (39.7%). According to Tsimberidou et al., 10/46 (21.7%) RS were in the low-risk group, 10 in the low-intermediate risk group, 11 (23.9%) in the high-intermediate risk group and the other 15 in the high-risk group. According to the Rossi score, only 4/51 RS (7.8%) were low risk, and 19 (37.3%) and 28 (54.9%) intermediate and high-risk, respectively. The most frequent treatment for RS was R-CHOP-like regimen [38/56 (67.9%)], 5 and 2 patients received autologous or allogeneic stem cell transplantation respectively. Most patients, 40/56 (71.4%) failed to reach complete remission after the first line. By bivariate analysis (Figure 1b-e), ECOG PS, platelet count and TP53 disruption worsened OS (p1, platelet count RS outcome is poor. Here, we focused specifically on Richter cells on diagnostic biopsies for genetic analyses. Unmutated IGHV status was identified as prognostic factor for RS, in addition to the previously described: ECOG PS, platelet count and TP53 disruption. More molecular studies are necessary to increase knowledge about RS and improve the survival of patients with DLBCL-type RS. Disclosures Dartigeas: Janssen: Honoraria; Roche: Honoraria; Gilead: Other: non-financial support. Tausch:Roche: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Janssen-Cilag: Consultancy, Honoraria, Research Funding. Leblond:Roche: Consultancy, Honoraria, Other: Travel/accommodations/expenses, Research Funding, Speakers Bureau; AbbVie: Consultancy, Honoraria, Other: Travel/accommodations/expenses, Research Funding, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Gilead: Honoraria, Speakers Bureau; Amgen: Honoraria; AstraZeneca: Consultancy, Honoraria; Lilly: Consultancy. Thieblemont:Incyte: Honoraria; Bristol-Myers Squibb: Consultancy, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Cellectis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Speakers Bureau; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company), Research Funding; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel support; Kite, a Gilead Company: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: TRAVEL, ACCOMMODATIONS, EXPENSES (paid by any for-profit health care company); Hospira: Research Funding; Bayer: Honoraria. Laribi:abbvie: Honoraria, Research Funding; amgen: Research Funding; novartis: Honoraria, Research Funding; takeda: Research Funding. Stilgenbauer:F. Hoffmann-LaRoche: Consultancy, Honoraria, Other: travel support, Research Funding; Genentech: Consultancy, Honoraria, Other: travel support, Research Funding; Genzyme: Consultancy, Honoraria, Other: travel support, Research Funding; Gilead: Consultancy, Honoraria, Other: travel support, Research Funding; GlaxoSmithKline: Consultancy, Honoraria, Other: travel support, Research Funding; Janssen-Cilag: Consultancy, Honoraria, Other: travel support, Research Funding; Mundipharma: Consultancy, Honoraria, Other, Research Funding; Novartis: Consultancy, Honoraria, Other, Research Funding; Pharmacyclics: Consultancy, Honoraria, Other, Research Funding; Boehringer-Ingelheim: Consultancy, Honoraria, Other: travel support, Research Funding; Celgene: Consultancy, Honoraria, Other: travel support, Research Funding; Amgen: Consultancy, Honoraria, Other: travel support, Research Funding; AbbVie: Consultancy, Honoraria, Other: travel support, Research Funding. Guieze:abbvie: Honoraria, Other: advisory board, travel funds; janssen cilag: Honoraria, Other: advisory board, travel funds; roche: Other: travle funds; gilead: Honoraria, Other: travel funds; astrazanecka: Honoraria, Other: advisory board. Feugier:gilead: Consultancy, Honoraria, Research Funding; janssen: Consultancy, Honoraria, Research Funding; roche: Consultancy, Honoraria, Research Funding; abbvie: Consultancy, Honoraria, Research Funding; astrazeneca: Consultancy, Honoraria, Research Funding. Broséus:Novartis: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; AstraZeneca: Consultancy, Honoraria; Gilead: Honoraria.