Evaluating rituximab plus lenalidomide for recurrent or non-responsive indolent non-Hodgkin lymphoma

This study evaluated the safety and effectiveness of rituximab (Rituxan) plus lenalidomide (Revlimid) for patients with recurrent or non-responsive non-Hodgkin’s lymphoma (NHL). This study concluded that lenalidomide was well-tolerated and improved the effectiveness of rituximab in these patients.

Follicular lymphoma (FL) and marginal zone lymphoma (MZL) are two of the most common types of painless (indolent) NHL. Rituximab monotherapy (single agent therapy) is the most common treatment for patients with recurrent FL or MZL. However, not all patients respond to rituximab alone. These patients need alternative treatment options.

The safety of effectiveness of lenalidomide added to rituximab treatment for patients with FL and MZL remain under investigation.

This study involved 358 patients with recurrent or non-responsive painless FL or MZL. 24% of patients received an average of 3 or more prior lines of treatment. All patients received rituximab. In addition, 178 patients received lenalidomide and 180 patients received a placebo. Patients were followed-up for an average of 28.3 months.

Overall, significantly more patients in the lenalidomide group responded to treatment compared to the placebo group (78% vs. 53%). Time from treatment until tumor growth or spread was significantly higher in the lenalidomide group compared to the placebo group (39.4 months vs. 14.1 months). The probability of not having tumor growth or spread 2 years later was significantly higher in the lenalidomide group (58% vs. 36%). Lenalidomide was significantly associated with a 54% lower risk of tumor growth or spread.

Overall, 99% (lenalidomide) and 96% (placebo) of patients had any side effects. The most common side effect was low neutrophil count (immune cells involved in fighting infections; 58% vs. 22%). Constipation (26% vs. 14%), low white blood cell count (20% vs. 9%), and low red blood cell count (16% vs. 4%) were also reported.

More patients in the lenalidomide group had severe side effects compared to the placebo group (69% vs. 32%). The most common was severe low neutrophil count (50% vs. 13%). These patients recovered from this side effect within an average of 9 days.

This study concluded that lenalidomide was well-tolerated and improved the effectiveness of rituximab in patients with painless NHL.

This study received funding support from Celgene, the manufacturer of lenalidomide.

Talk to your care team about the potential benefits of adding lenalidomide to rituximab monotherapy.