I have a fit 83-year old patient with a history of SLL (CD5 positive, lambda restricted), stage 3A non-bulky, treated with six cycles of bendamustine and rituximab in 2016. They now have a cervical lymph node biopsy showing DLBCL (CD5 negative, lambda restricted). PET-CT shows stage 1A bulky (8 cm lymph node conglomerate) disease. They have no clear evidence of SLL elsewhere, and bone marrow biopsy and peripheral blood flow cytometry are within normal limits. Do you consider this Richter's transformation? What treatment would you recommend for this patient?
Yes I would consider this Richter’s. Sometimes there can be loss of CD5. I would suggest 3 cycles of R-CHOP and XRT. Even though he is fit, it would be a good idea to dose reduce at least the first cycle (mini-R-CHOP) to assess tolerance
