<prompt> Ritcher transformation, CLL transforms toDiffuse large B-cell lymphomaAnaplastic Large Cell LymphomaBurkitt lymphomaMultiple myeloma  <response>: Richters Syndrome RS, also known as Richters Transformation, is a rare complication of Chronic Lymphocytic Leukaemia CLL andor Small Lymphocytic Lymphoma SLL. It is characterised by the sudden transformation of the CLLSLL into a significantly more aggressive form of large cell lymphoma. Richters Syndrome occurs in approximately 2-10 of all CLLSLL patients during the course of their disease. In the most cases the normally slow growing, or indolent, CLL transforms into a common type of non-Hodgkin lymphoma NHL known as Diffuse Large B-Cell Lymphoma DLBCL. Rarer cases transform into Hodgkin lymphomaHLHodgkin Disease HD, and some types of T-cell lymphomas also have been repoed The most common symptoms of Richters Syndrome arise from a sudden and dramatic increase in the size of lymph nodes also known as lymphadenopathy characterised by usually painless areas of swelling in the neck, axilla, abdomen most commonly in the spleen, also known as splenomegaly or groin. Patients also often experience a dramatic increase in unexplained weight loss, fevers and night sweats often collectively referred to as B-symptoms. Other signs and symptoms may include low haemoglobin anaemia characterised by: increasing fatigue shoness of breath dizziness and possible palpitations low platelets thrombocytopaenia characterised by excessive bruising or bleeding an increase in serum lactate dehydrogenase LDH or elevated serum calcium hypercalcaemia on routine blood tests. It is impoant to note that whilst some of these signs and symptoms may already be present to a lesser degree in people with previously diagnosed CLLSLL, the possibility of Richters Syndrome needs to be considered if there is a sudden and dramatic increase in these symptoms, which is not generally considered to be a typical feature of normally relatively indolent CLLSLL disease. Richters syndrome is a serious complication of CLLSLL and unfounately is often fatal. If Richters syndrome is diagnosed, it is advised that the person should seek recommended treatments, but also to get their lives in order to prepare for any outcome. You may wish to discuss an advanced health directive with your treatment team, to let them and your family know how you would like your health to be managed if your treatments are not successful Richters Syndrome affects approximately 2-10 of patients with a prior diagnosis of CLLSLL and can occur at any time throughout the course of the disease. Ref Davidson 23rd edition pg 789 