Advanced Practice

Richter Transformation Arising From Chronic Lymphocytic Leukemia

Barbara B. Rogers

Richter transformation, diffuse large B-cell lymphoma, chronic lymphocytic leukemia
CJON 2022, 26(1), 14-17. DOI: 10.1188/22.CJON.14-17

This article presents a case of a patient diagnosed with an indolent form of chronic lymphocytic leukemia (CLL). He was being followed with close observation when he was diagnosed with Richter transformation, an aggressive lymphoma that develops from CLL. The development of Richter transformation carries a poor prognosis, in part, because of underlying molecular changes that give rise to the transformation. The prognosis also relates to the difficulty in the patient’s ability to receive chemotherapy because of poor marrow reserves from the disease or the residual impact of prior treatments. Advanced practice nurses who follow patients with CLL need to be aware of the potential for Richter transformation.


  • Richter transformation, an aggressive form of lymphoma, is characterized by the rapid growth of lymphadenopathy, onset of B symptoms, extranodal disease, significant elevations of lactate dehydrogenase, and multiorgan dysfunction.
  • Richter transformation may be treated with chemoimmunotherapy regimens, including the use of novel agents; allogeneic transplantation may be used in consolidation of the disease.
  • By understanding Richter transformation, advanced practice nurses can initiate swift diagnosis and treatment for this condition.
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