title: Phase II study of lenalidomide and rituximab as salvage therapy for patients with relapsed or refractory chronic lymphocytic leukemia.
abstract: OBJECTIVE
  Lenalidomide is an immunomodulatory drug active as salvage therapy for chronic lymphocytic leukemia (CLL). We combined lenalidomide with rituximab to improve response rates in patients with relapsed or refractory CLL.
  
  
  METHODS
  Fifty-nine adult patients (age 42 to 82 years) with relapsed or refractory CLL were enrolled onto a phase II study of lenalidomide and rituximab. Patients had received prior fludarabine-based therapy or chemoimmunotherapy. Rituximab (375 mg/m(2) intravenously) was administered weekly during cycle one and on day 1 of cycles three to 12. Lenalidomide was started on day 9 of cycle one at 10 mg orally and administered daily continuously. Each cycle was 28 days. Rituximab was administered for 12 cycles; lenalidomide could continue indefinitely if patients benefitted clinically.
  
  
  RESULTS
  The overall response rate was 66%, including 12% complete responses and 12% nodular partial remissions. Time to treatment failure was 17.4 months. Median overall survival has not been reached; estimated survival at 36 months is 71%. The most common grade 3 or 4 toxicity was neutropenia (73% of patients). Fourteen patients (24%) experienced a grade 3 to 4 infection or febrile episode. There was one episode of grade 3 tumor lysis; one patient experienced renal failure during the first cycle of therapy, and one venous thromboembolic event occurred during the study.
  
  
  CONCLUSIONS
  The combination of lenalidomide and rituximab is active in patients with recurrent CLL and warrants further investigation.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Xavier C
authors.initials: XC
authors.lastname: Badoux
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Keating
authors.forename: Sijin
authors.initials: S
authors.lastname: Wen
authors.forename: William G
authors.initials: WG
authors.lastname: Wierda
authors.forename: Susan M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: Stefan
authors.initials: S
authors.lastname: Faderl
authors.forename: Rachel
authors.initials: R
authors.lastname: Sargent
authors.forename: Jan A
authors.initials: JA
authors.lastname: Burger
authors.forename: Alessandra
authors.initials: A
authors.lastname: Ferrajoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D019008:Drug Resistance, Neoplasm; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects; D007239:Infections / Q000150:complications / Q000276:immunology; D053208:Kaplan-Meier Estimate; D000077269:Lenalidomide; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods*; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab; D013792:Thalidomide; D000077269:Lenalidomide