EHA Guidelines on management of chronic lymphocytic leukemia and Richter transformation

Previous editions of the European guidelines for the management of chronic lymphocytic leukemia (CLL) were developed by experts in CLL under the auspices of the European Society for Medical Oncology (ESMO). These previous editions have served as a reference text for many physicians caring for patients with CLL. The current, 2026 edition, represents the new, updated guidelines that, for the first time (and in agreement with ESMO), were written on behalf of the European Hematology Association (EHA), which will be solely responsible for subsequent editions, published annually to keep pace of the fast-moving field of CLL research and clinical applications. The new guidelines support approaching the management of CLL in a more holistic fashion, from the initial diagnosis (including active surveillance) to treatment need, with particular emphasis on the interplay between disease- and patient-specific criteria for decision-making, to the latest stage of possible Richter transformation, which is now specifically mentioned in the title of the guidelines. These new recommendations are the result of a consensus reached among medical experts from several European countries and, for the first time, have involved patient advocacy representatives, which is in line with EHA standard operating procedures for clinical practice guideline development. Updates in terms of treatment options include the recently European Medicines Agency-approved, time-limited combination therapy acalabrutinib and venetoclax ± obinutuzumab as first-line treatment, and continuous pirtobrutinib for patients exposed to covalent Bruton's tyrosine kinase inhibitors in the relapsed/refractory setting.