Richter's transformation in CLL is characterized by transformation to which aggressive lymphoma in most cases?
- A Follicular lymphoma
- B Diffuse large B-cell lymphoma (DLBCL) ✓
- C Mantle cell lymphoma
- D Burkitt lymphoma
Correct answer: B. Diffuse large B-cell lymphoma (DLBCL)
Explanation
Richter's transformation (RT) refers to the clonal evolution of CLL into an aggressive lymphoma; approximately 95% of cases transform to diffuse large B-cell lymphoma, with the remaining ~5% becoming Hodgkin lymphoma. RT occurs in 2–10% of CLL patients and carries a median survival of 6–12 months. Features suggesting RT include rapid lymph node enlargement, systemic B symptoms, rising LDH, and FDG-avid PET lesions with SUV >5. Clonally related RT (arising from the CLL clone) has a worse prognosis than clonally unrelated de novo DLBCL.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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