title: Single-agent lenalidomide in relapsed/refractory mantle cell lymphoma: results from a UK phase II study suggest activity and possible gender differences.
abstract: We present data from a phase II study investigating a novel treatment strategy for relapsed/refractory mantle cell lymphoma (MCL). Twenty-six patients received lenalidomide 25 mg/d (days 1-21 of a 28-d cycle) for up to 6 cycles followed by low-dose maintenance lenalidomide (15 mg) in responding patients. Eight patients achieved complete or partial response to give an overall response rate of 31% with median response duration of 22·2 months [95% confidence interval (CI) 0·0-53·6] and median progression-free survival (PFS) of 3·9 months (95% CI 0·0-11·1). An additional six patients (23%) achieved stable disease. Eleven patients received maintenance with median PFS of 14·6 months (95% CI 7·3-21·9). Correlative studies showed that peripheral T and Natural Killer (NK) cells increased in responding patients by 40-60% over the first 6 cycles with an initial dip in NK cells suggestive of tumour infiltration. Peripheral regulatory T cells were increased in MCL patients (P = 0·001) and expanded further following lenalidomide. Sequential plasma analysis showed increased IL12 p40 and IL7 alongside decreased MMP9, IL10, and adiponectin. Finally, a significant correlation (P = 0·02) between gender and response suggested that female MCL patients were more sensitive to lenalidomide than males. In summary, we confirm the activity, safety and immunomodulatory properties of lenalidomide in MCL and highlight its potential as a low-dose maintenance agent.
authors.affiliation: Department of Haematology, Derriford Hospital, Plymouth, UK. heathereve25@gmail.com
authors.forename: Heather E
authors.initials: HE
authors.lastname: Eve
authors.forename: Sean
authors.initials: S
authors.lastname: Carey
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Richardson
authors.forename: Carla C
authors.initials: CC
authors.lastname: Heise
authors.forename: Vidya
authors.initials: V
authors.lastname: Mamidipudi
authors.forename: Tao
authors.initials: T
authors.lastname: Shi
authors.forename: John A
authors.initials: JA
authors.lastname: Radford
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Auer
authors.forename: Sheila H
authors.initials: SH
authors.lastname: Bullard
authors.forename: Simon A J
authors.initials: SA
authors.lastname: Rule
mesh_terms: D052242:Adiponectin / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D053762:Interleukin-12 Subunit p40 / Q000097:blood; D000077269:Lenalidomide; D007958:Leukocyte Count; D020522:Lymphoma, Mantle-Cell / Q000097:blood / Q000401:mortality / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012727:Sex Characteristics; D012737:Sex Factors; D015996:Survival Rate; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D000970:Antineoplastic Agents; C508609:IL10 protein, human; C500879:IL12B protein, human; D053762:Interleukin-12 Subunit p40; D016753:Interleukin-10; D013792:Thalidomide; D000077269:Lenalidomide