Evaluating the effectiveness of lenalidomide plus rituximab for patients with recurrent or hard-to-treat DLBCL

This study evaluated the safety and effectiveness of lenalidomide (Revlimid) plus rituximab (Rituxan) for patients with diffuse large B-cell lymphoma (DLBCL) that came back or stopped responding to treatment. This study concluded that this treatment showed some effectiveness, but adding other agents may improve outcomes for these patients.

DLBCL is one of the most common types of non-Hodgkin lymphoma (NHL) in adults. Although most patients respond to initial treatment, some patients experience relapse (cancer comes back) or develop hard-to-treat (refractory) disease. Relapse in the central nervous system (brain or spinal cord; CNS) tends to be associated with poor outcomes.

DLBCL is also diagnosed when patients with follicular lymphoma (FL; a painless and slow-growing type of NHL) experience disease transformation. The cancer cells become more aggressive and transform into DLBCL. Transformed FL can be challenging to treat.

Immunotherapies such as rituximab are commonly used for the treatment of DLBCL. Lenalidomide is also an immunotherapy that is commonly used in multiple myeloma. However, it is unclear if lenalidomide plus rituximab is effective for patients with DLBCL or transformed FL.

This study included 24 patients. Of these, 21 patients had recurrent or hard-to-treat DLBCL. Three patients had transformed FL. Overall, 7 patients had cancer in the CNS. All patients received chemoimmunotherapy before treatment with lenalidomide and rituximab. On average, patients had an average of 4 previous lines of therapy. Patients were followed up for at least one year after treatment.

Overall, 38% of all patients responded to treatment. 21% of all patients had no signs of cancer after treatment. Three patients with cancer in the CNS responded to treatment. None of the patients with transformed FL responded to treatment.

The average survival of all patients was 7.3 months, with 1.8 months having no tumor growth or spread. 15 patients experienced tumor growth or spread after treatment.

Overall, 75% of patients reported low white blood cell count. Among these, 62.5% of cases were moderate to severe. Patients also reported moderate to severe low red blood cell count (46%) and low platelet count (50%). Most side effects were manageable with appropriate treatment. Only four patients had treatment dose adjustments due to side effects.

This study concluded that lenalidomide plus rituximab showed some effectiveness for patients recurrent or hard-to-treat DLBCL. The authors suggest that adding other agents or chemotherapy regimens to this combination may improve outcomes, particularly for patients with transformed FL.

This study looked back in time to analyze data. Also, this study had a small number of patients. There was no comparison group. Larger studies are needed to confirm these results.