Cellular Therapy in High-Risk Relapsed/Refractory Chronic Lymphocytic Leukemia and Richter Syndrome

Maria Chiara Barbanti; Niamh Appleby; Murali Kesavan; Toby Andrew Eyre

doi:10.3389/fonc.2022.888109

Cellular Therapy in High-Risk Relapsed/Refractory Chronic Lymphocytic Leukemia and Richter Syndrome

Front Oncol. 2022 Apr 28:12:888109. doi: 10.3389/fonc.2022.888109. eCollection 2022.

Authors

Maria Chiara Barbanti^{1

2}, Niamh Appleby^{1

2}, Murali Kesavan^{1

2}, Toby Andrew Eyre^{1

2}

Affiliations

¹ Department of Clinical Haematology, Oxford Cancer and Haematology Centre, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
² Clinical Trials Unit, Department of Oncology, Churchill Hospital, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, United Kingdom.

Abstract

Despite the development of highly effective, targeted inhibitors of B-cell proliferation and anti-apoptotic pathways in chronic lymphocytic leukemia (CLL), these treatments are not curative, and many patients will develop either intolerance or resistance to these treatments. Transformation of CLL to high-grade lymphoma-the so-called Richter syndrome (RS)-remains a highly chemoimmunotherapy-resistant disease, with the transformation occurring following targeted inhibitors for CLL treatment being particularly adverse. In light of this, cellular therapy in the form of allogenic stem cell transplantation and chimeric antigen receptor T-cell therapy continues to be explored in these entities. We reviewed the current literature assessing these treatment modalities in both high-risk CLL and RS. We also discussed their current limitations and place in treatment algorithms.

Keywords: CAR (chimeric antigen receptor) T-cell therapy; CLL (chronic lymphocytic leukemia); allogenic stem cell transplantation; cellular therapy; richter syndrome.

Publication types

Review