Medically reviewed by Dr. Brian Koffman
The Bottom Line:
Ten-year follow-up data showed that lenalidomide plus rituximab produced high response rates in patients with CLL with no significant safety signals. Lenalidomide might be useful as a combination therapy because its immunomodulatory properties can potentially improve T cell function and the immune response.
Who Performed the Research and Where Was it Presented:
Dr. Benjamin Heyman from Moores Cancer Center at the University of California San Diego and colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting 2023.
Background:
Recently, there has been increased interest in immunotherapies for treating CLL, so researchers were interested in taking another look at the data on lenalidomide. This immunomodulatory drug is approved for treating multiple myeloma and mantle cell lymphoma. Lenalidomide has been tested in clinical trials for treating CLL, and it showed promising efficacy in high-risk CLL. However, its development as a CLL therapy was discontinued due to concerns about its side effects. This study looked at patient outcomes ten years after lenalidomide plus rituximab treatment.
Methods and Participants:
This was a long-term follow-up analysis of two phase 2 clinical trials of lenalidomide plus rituximab in patients with treatment-naïve or relapsed / refractory CLL. Treatment lasted for approximately six months.
Results
- This was 10-year follow-up data from 43 treatment-naïve patients and 25 relapsed / refractory patients.
- Most patients had advanced disease (Rai stage 3 or 4).
- About 82% of patients responded to treatment, but only 13% had a complete response.
- Very few patients (1.5%) had progressive disease while on treatment.
- No patients achieved undetectable measurable residual disease (uMRD).
- Only two cases of blood clots in veins (venous thromboembolism) occurred during active treatment in patients who had not been taking preventative medication (aspirin) appropriately.
- During follow-up, five other patients developed blood clots in their veins.
- Three out of ten patients had significantly low neutrophils (neutropenia), 6 of 10 significant low platelets, and 3 of 10 significant anemia.
- 43.5% developed skin cancers, and 12.9% developed other solid cancers.
- No deaths were related to the study treatment. Most were due to progressive disease or other natural causes.
Conclusion:
Lenalidomide plus rituximab produced high response rates in patients with CLL, though the responses were not deep. In this group of patients, there were no significant long-term safety signals. This combination would not be used as a standalone therapy in today’s treatment landscape with the advent of numerous BTK inhibitors and venetoclax. However, it might still have utility as part of a combination therapy because its immunomodulatory properties can potentially improve T cell function and the immune response.
Links and Resources:
Watch the interview on the abstract here:
You can read the ASH abstract here: A Long-Term Analysis of Lenalidomide and Rituximab (R 2) for the Treatment of Chronic Lymphocytic Leukemia.
Take care of yourself first.
Ann Liu, PhD
