title: Clinical experience with lenalidomide alone or in combination with rituximab in indolent B-cell and mantle cell lymphomas.
abstract: Lenalidomide is an oral immunomodulatory drug with significant activity in indolent B-cell and mantle cell lymphomas. Lenalidomide has a manageable safety profile whether administered as a single agent or in combination with rituximab. The combination of lenalidomide with rituximab, known as the 'R(2)' regimen, enhances efficacy over what has been shown with monotherapy and has demonstrated activity in patients considered resistant to rituximab. Tolerability of these regimens has been consistent among studies. Asymptomatic neutropenia is the most common grade 3/4 adverse event, typically managed by dose interruption, followed by dose reduction once neutrophils have recovered. Nonhematologic toxicities (e.g. fatigue) are generally low-grade, manageable with concomitant treatment, and/or lenalidomide dose modification. More frequent with R(2), immune-related symptoms such as rash and tumor flare are important to recognize as lenalidomide-associated treatment effects in patients with lymphoma who require supportive care and potential dose modifications. Severe tumor flare reactions with painful lymphadenopathy are not typically observed outside of chronic lymphocytic leukemia/small lymphocytic lymphoma. Venous thromboembolism is uncommon in lymphomas, though prophylaxis is recommended. The general safety profile, differences between lenalidomide monotherapy and R(2) treatment, and optimal strategies for managing adverse events are discussed here.
authors.affiliation: Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York jruan@med.cornell.edu.
authors.forename: J
authors.initials: J
authors.lastname: Ruan
authors.affiliation: Division of Hematology and Medical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa.
authors.forename: B
authors.initials: B
authors.lastname: Shah
authors.affiliation: Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York.
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.affiliation: Division of Hematology and Medical Oncology, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Schuster
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001402:B-Lymphocytes / Q000187:drug effects / Q000473:pathology; D019008:Drug Resistance, Neoplasm / Q000187:drug effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000473:pathology; D006801:Humans; D000077269:Lenalidomide; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000473:pathology; D000069283:Rituximab / Q000008:administration & dosage* / Q000009:adverse effects; D013792:Thalidomide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000069283:Rituximab; D013792:Thalidomide; D000077269:Lenalidomide
keywords: lenalidomide; mantle cell lymphoma; non-Hodgkin lymphoma; rituximab; safety