title: Lenalidomide in heavily pretreated refractory diffuse large B-cell lymphoma: a case report.
abstract: BACKGROUND
  In diffuse large B-cell lymphoma, first-line treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone; salvage with cisplatin-based regimens for relapsing patients; and autologous stem cell therapy are standards of care. Treatment approaches are less clear for patients who are refractory or who are not candidates for autologous stem cell therapy. Options may include palliative regimens or clinical trial enrollment. One therapy under investigation in diffuse large B-cell lymphoma is lenalidomide, an immunomodulatory agent with antiangiogenic activity.
  
  
  METHODS
  We present the case of a 55-year-old Caucasian male patient diagnosed with diffuse large B-cell lymphoma who had an early relapse after treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. He then had a subsequent early relapse after cisplatin-based salvage consolidated with autologous stem cell therapy. The efficacy of gemcitabine-cisplatin-rituximab was limited to five months, followed by systemic and central nervous system progression. Fourth-line treatment with lenalidomide plus rituximab and involved-field radiotherapy followed by lenalidomide monotherapy greatly improved this patient's quality of life and performance status, allowing over two years of progression-free survival to date (excluding a brief relapse due to treatment interruption).
  
  
  CONCLUSIONS
  A lenalidomide-based regimen was highly effective in this patient with diffuse large B-cell lymphoma.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Krawczyk
authors.affiliation: Department of Hematology, Jagiellonian University, Kopernika 17, Kraków 30-501, Poland. wojciech.jurczak@lymphoma.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jurczak
authors.forename: Krystyna
authors.initials: K
authors.lastname: Gałązka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Gruchała
authors.forename: Aleksander B
authors.initials: AB
authors.lastname: Skotnicki
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D000077269:Lenalidomide; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D000069283:Rituximab; D016879:Salvage Therapy / Q000379:methods*; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab; D013792:Thalidomide; D000077269:Lenalidomide