Lenalidomide treatment for B-cell non-Hodgkin lymphomas

This study reviewed the use of lenalidomide (Revlimid) in B-cell non-Hodgkin lymphomas.

Non-Hodgkin lymphoma (NHL) is a highly treatable and curable form of cancer. NHL can be slow-growing, such as follicular lymphoma (FL). It can also be aggressive, such as diffuse large B-cell lymphoma (DLBCL). Both types are generally treated with the monoclonal antibody rituximab (Rituxan) and a combination of chemotherapy. A common combination is CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). Bendamustine (Treanda) is another effective chemotherapy. However, treatment is often limited by the side effects caused by the medications. Patients may not be able to tolerate treatment or may relapse.

Lenalidomide is a treatment that both stimulates the immune system to fight the lymphoma cells and delivers an agent to kill the cells. This treatment is approved for use in another form of NHL, mantle cell lymphoma (MCL). It has also been shown to be effective in FL and DLBCL, particularly in combination with rituximab.

The current study reviewed the use of lenalidomide in B-cell lymphomas.

Mantle Cell Lymphoma

Treatment for MCL can be difficult, as patients are often older with other medical conditions. Many cannot tolerate the side effects of chemotherapy. Lenalidomide has been examined in patients who have relapsed or who have not responded to treatment (refractory). In one study including 134 patients, 28% saw a response to lenalidomide and 8% saw a complete response (no sign of active disease). The response lasted for an average of 16.6 months. Other smaller studies have reported higher response rates. Combining lenalidomide with bortezomib (Velcade) has also been shown to be effective. In 38 previously untreated patients, lenalidomide plus rituximab led to a response in 92%. 64% saw a complete response. 85% were progression free after two-years. Adding bendamustine has also been shown to be effective.

Follicular Lymphoma

FL is often diagnosed at an advanced stage. In patients who have relapsed, lenalidomide plus rituximab (known as R²) has led to a response in 33% to 74%. Complete responses have been reported in 18% to 44%. The combination treatment improves response over lenalidomide alone. In patients who have not had prior treatment, R² has led to a response in 75% to 96%, and complete response in 36% to 71%, depending on the study.

Diffuse Large B-Cell Lymphoma

DLBCL is an aggressive but still curable form of NHL. Most relapses happen within 2 years of treatment. In relapsed/refractory patients, lenalidomide led to an overall response rate of 35% and a complete response in 13%. In patients who had undergone prior stem cell (immature blood cell) transplantation, the overall response rate was 37%. R² led to a response in 33% of 45 patients and a complete response in 22%. Lenalidomide has been combined with other treatments with some success. These include the chemotherapy R-DHAP and the targeted therapy ibrutinib. The success of lenalidomide in patients who have not been treated before depends on the subtype of DLBCL. For example, the standard treatment R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) is more effective in patients with GCB-DLBCL. Adding lenalidomide to R-CHOP led to a 98% response rate in 64 patients, with a complete response in 80%. 80% of patients were still alive after 24 months. In comparison, R-CHOP has historically led to a 46% 2-year survival rate in ABC-DLBCL.

This study concluded that lenalidomide is a promising treatment option for multiple forms of non-Hodgkin lymphoma.