Note from the editor: Occasionally, we find a helpful article that we hope will never be needed. This is one such article. If Richter transformation (Richter syndrome) does occur, this resource will be important to have available
Richter transformation (RT) is a rare but serious change that can happen in people with chronic lymphocytic leukemia (CLL), where the slower-growing CLL becomes a more aggressive form of lymphoma.
An international group of experts recently created comprehensive guidelines for diagnosing, treating and monitoring RT. These guidelines were published in Blood in July 2025, and they offer important insights for patients, families, and healthcare teams.
One of the features of the article that makes it useful for patients is the way test procedures, diagnostic steps and treatment options are summarized in easy-to-read tables. If you are a patient facing RT, these tables are a helpful tool to understand what you’re experiencing and what you can expect during treatment. The information the tables provide will help you know if your care is aligned with best practices. If your care doesn’t follow the practices outlined in the tables, you can use this information to discuss your care plan with your medical team and advocate for the best possible approach.
Although it’s rare, RT occurs in about 2-10% of CLL patients, with the most common form being diffuse large B-cell lymphoma (DLBCL), a fast-growing lymphoma.
Currently, no single treatment has proven best for RT. Many patients are given R-CHOP, a chemotherapy and antibody combination used for aggressive lymphomas.
While current therapies are effective for some people, new treatments such as CAR T-cell therapy, antibody-based drugs and targeted combinations are being studied in clinical trials and offer real hope for better outcomes. It is important to note that even if the RT component responds well to treatment, the underlying CLL doesn’t disappear. Patients will continue to live with CLL and may require ongoing care.
Looking ahead, researchers are studying how RT develops and why some CLL patients are more likely to experience it. The hope is that one day doctors may be able to identify who is at higher risk and possibly prevent RT from occurring at all. Though RT remains a difficult condition there is real momentum towards better treatment options, and with continued progress, the future looks more promising for people facing RT.
Further detail can be found in the full article. Additional information on Richter Transformation can be found in CLL Canada’s Information and Resource Centre in the “Complications of CLL” (secondary cancers) section.