Evaluating rituximab plus lenalidomide for first-line treatment of follicular lymphoma

This study evaluated the effectiveness of rituximab (Rituxan) alone or with lenalidomide (Revlimid) for the first-line treatment of follicular lymphoma (FL). This study concluded that rituximab plus lenalidomide was effective and well-tolerated in these patients.

Immunochemotherapy is the current standard first-line treatment for patients with FL. This treatment combines immunotherapy and chemotherapy to stimulate the immune system to attack and destroy cancer cells. However, immunochemotherapy is associated with side effects that can lead to long-term complications. Treatment options with fewer side effects are needed.

Chemotherapy-free therapies are under investigation. Rituximab monotherapy (single agent therapy) is one example. However, not all patients respond to rituximab alone. Adding lenalidomide to rituximab monotherapy may be more effective. Lenalidomide boosts the body’s immune system to help it attack cancer cells. This leads to cancer cell death. Whether rituximab plus lenalidomide is more effective than rituximab alone for the treatment of FL is unclear.

This study involved 154 patients with FL that was not treated before. Half of the patients received rituximab alone, and the other half received rituximab with lenalidomide (RL) for 15 weeks. Patients were followed-up for an average of 4 years.

After 23 weeks, significantly more patients in the RL group had a complete disappearance of all signs of cancer (36% vs. 25%). This rate was also significantly higher for patients age 70 or older (33% vs. 8%).

At follow-up, 91% (RL) and 90% (rituximab) of patients were still alive. However, the average survival without tumor growth or spread was significantly longer in the RL group compared to the rituximab group (5.0 years vs. 2.3 years).

Overall, more patients in the RL group reported side effects compared to the rituximab group (100% vs. 91%). Most side effects were mild. The most common ones were tiredness (52%), nausea (22%), and skin rash (27%). Serious side effects were also more common in the RL group (56% vs. 22%). Serious low white blood cell count was the most common (23% vs. 7%).

More patients in the rituximab group stopped treatment due to poor treatment response compared to the RL group (21% vs. 4%). However, more patients in the RL group stopped treatment due to side effects compared to the rituximab group (13 patients vs. 1 patient).

This study concluded that the RL regimen was effective in patients with FL, with manageable side effects. The authors suggest that this regimen may be an alternative to standard immunochemotherapy.

This study was small. Larger studies are needed to confirm these results.