Can lenalidomide maintenance improve survival after autologous hematopoietic stem-cell transplantation in patients with mantle cell lymphoma?

This study investigated whether lenalidomide maintenance therapy after intensive chemoimmunotherapy and first-line autologous hematopoietic stem-cell transplantation (AHSCT) improved the outcomes of patients with mantle cell lymphoma (MCL). The data showed that lenalidomide maintenance after AHSCT improved the survival without cancer worsening in these patients at the cost of more toxicity.

Mantle cell lymphoma (MCL) is an aggressive type of non-Hodgkin lymphoma (NHL). It can be challenging to treat. There is no single standard treatment for patients with MCL. However, for young and fit patients, intensive chemotherapy followed by AHSCT is usually recommended. However, there is still a risk of relapse after treatment.

Maintenance treatment is commonly used after first-line treatment in some cancers to delay relapse or slow down cancer progression. Lenalidomide (Revlimid) is an immunotherapy drug used to treat various types of cancers. Lenalidomide boosts the body’s immune system to help it attack cancer cells. This leads to cancer cell death. It has been used as maintenance treatment in some types of blood cancers. However, whether lenalidomide is beneficial after intensive chemoimmunotherapy and first-line AHSCT in patients with MCL is still not known.

This study involved 300 patients with MCL who underwent chemoimmunotherapy and AHSCT. 205 patients after AHSCT achieved complete or partial disappearance of cancer. 104 patients were randomly assigned to receive lenalidomide maintenance and 101 patients were assigned to the observation group. The average follow-up time was 38 months.

The 3-year survival rate without cancer progression was 80% in the lenalidomide group and 64% in the observation group. Lenalidomide maintenance was associated with a 49% higher chance of not having the cancer progress. The 3-year overall survival rate was 93% in the lenalidomide group and 86% in the observation group. The 3-year disease-free survival was 83% in the lenalidomide group and 65% in the observation group. 

Treatment-related deaths were recorded in 2% of patients in the lenalidomide group and 1% in the observation group. 63% of patients in the lenalidomide group had blood-related side effects compared with 12% of patients in the observation group. 31% of patients in the lenalidomide group and 8% of patients in the observation group had non-blood-related side effects. Pneumonia and other infections were the most common side effects.

This study concluded that lenalidomide maintenance after first-line AHSCT significantly improved progression-free survival while increasing the risk of side effects in patients with MCL.

This study received funding support from Celgene, the manufacturer of lenalidomide. Lenalidomide leading to a lot of second cancers is a major concern.