How does maintenance therapy affect quality of life for patients with DLBCL?

This study evaluated lenalidomide (Revlimid) maintenance therapy versus placebo for patients with diffuse large B-cell lymphoma (DLBCL). The authors found that lenalidomide increased the number of side effects but did not impact health status.

DLBCL is an aggressive type of non-Hodgkin's lymphoma. First-line treatment usually involves chemotherapy. About two-thirds of patients respond well to treatment. However, in a third of patients, the cancer continues to grow or returns (relapses). 

Maintenance therapy is a less aggressive type of therapy given after first-line treatment to help delay relapse. Lenalidomide is a common maintenance therapy option. Previous studies showed that lenalidomide maintenance therapy improved survival outcomes for patients with DLBCL. However, it is unclear how lenalidomide treatment affects the quality of life for these patients.

263 patients with DLBCL were divided into two groups. 136 patients received lenalidomide maintenance therapy, and 127 patients received a placebo (substance with no active effect). Health status was assessed for all patients at different points over a year. Side effects were assessed by physicians and self-reported by patients.

Before treatment, the health status of both groups was similar and remained so for the duration of the study. In the lenalidomide group, health status dropped significantly only at cycle 21 of treatment. In the placebo group, health status increased significantly only in cycle 12.

Side effects reported by a physician were higher in the lenalidomide group (81.1%) than the placebo (66.3%). More patients in the lenalidomide group reported side effects (63%) than the placebo group (46.7%). 

Treatment dose can be reduced if needed to minimize side effects. In the lenalidomide group, 54.3% of physician-reported side effects led to dose reductions compared to 22.6% in the placebo group. The most common side effect that led to dose reduction was low white blood cell count (45.3% vs. 15.2%). 

Among patient-reported side effects, 26.4% (lenalidomide) led to dose reductions compared to 11.8% in the placebo group. The most common side effects that led to dose reduction were rash (4.3%, lenalidomide) and sensory issues (2.5%, placebo).

Dose reduction did not reduce treatment effectiveness.

The authors concluded that lenalidomide did not reduce health status and treatment effectiveness compared to a placebo. However, more side effects were reported in the lenalidomide group.

The manufacturer of lenalidomide, Celgene, funded this study. Not all patients completed the study, which may have affected results.

Talk to your doctor about whether maintenance therapy may be right for you.