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Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma

BACKGROUND: Approximately 40% patients of diffuse large B‐cell lymphoma (DLBCL) would develop disease recurrence/progression after first‐line R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) induction therapy, with highly poor prognosis. An effective strategy to prolong...

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Autores principales: Wang, Xiaoyan, Yu, Lu, Jiang, Xinlu, Ding, Kaiyang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225180/
https://www.ncbi.nlm.nih.gov/pubmed/36912128
http://dx.doi.org/10.1002/cam4.5790
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author Wang, Xiaoyan
Yu, Lu
Jiang, Xinlu
Ding, Kaiyang
author_facet Wang, Xiaoyan
Yu, Lu
Jiang, Xinlu
Ding, Kaiyang
author_sort Wang, Xiaoyan
collection PubMed
description BACKGROUND: Approximately 40% patients of diffuse large B‐cell lymphoma (DLBCL) would develop disease recurrence/progression after first‐line R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) induction therapy, with highly poor prognosis. An effective strategy to prolong the survival of this patient population is the additional single‐drug maintenance therapy. lenalidomide, an immunomodulatory drug with oral activity, has direct anti‐tumor activity and indirect effects mediated by multiple immune cells in the tumor microenvironment, such as B, T, natural killer (NK), and dendritic cells. Combining its controllable toxicity, it is promising in long‐term maintenance therapy. This study aims at evaluating the clinical effect of lenalidomide maintenance therapy in responding DLBCL patients with R‐CHOP treatment. METHODS: This retrospective study was devised in DLBCL cases who obtained complete response (CR) or partial response (PR) following 6–8 cycles of R‐CHOP treatment between January 1, 2015 and July 31, 2019. Patients (n = 141) included were respectively assigned to receive lenalidomide maintenance treatment (lenalidomide, n = 50) and drug‐free maintenance treatment (control, n = 91) after CR/PR. lenalidomide was provided orally at 25 mg/day for 10 days, with a cycle of 21 days and a treatment course of 2 years. Progression‐free survival (PFS) was taken as the primary outcome. RESULTS: Of the total 141 subjects, the median follow‐up time was 30.9 months (range, 5.7–68.9 months). The 2‐year PFS was 84% (95% CI: 74%–94%) in the lenalidomide group and 53% (95% CI: 43%–63%) in the control group. The median PFS of the lenalidomide group was not reached, and that of the control group was 42.9 months (HR = 0.32; 95% CI: 0.16–0.63; p = 0.001). No remarkable difference in overall survival (OS) between the two groups was indicated (HR = 0.42; 95% CI: 0.16–1.12; p = 0.08). Central nervous system (CNS) recurrence happened in 5 patients (5.5%) of the control group, while none of the patients with lenalidomide had CNS recurrence. Additionally, neutropenia and cutaneous reactions were the most common Grade 1–2 adverse reactions after lenalidomide treatment, and neutropenia was the most frequent Grade 3–4 adverse reaction. CONCLUSION: Two‐year lenalidomide maintenance treatment can significantly prolong the PFS of DLBCL patients who obtained CR/PR to first‐line R‐CHOP treatment.
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spelling pubmed-102251802023-05-29 Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma Wang, Xiaoyan Yu, Lu Jiang, Xinlu Ding, Kaiyang Cancer Med RESEARCH ARTICLES BACKGROUND: Approximately 40% patients of diffuse large B‐cell lymphoma (DLBCL) would develop disease recurrence/progression after first‐line R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) induction therapy, with highly poor prognosis. An effective strategy to prolong the survival of this patient population is the additional single‐drug maintenance therapy. lenalidomide, an immunomodulatory drug with oral activity, has direct anti‐tumor activity and indirect effects mediated by multiple immune cells in the tumor microenvironment, such as B, T, natural killer (NK), and dendritic cells. Combining its controllable toxicity, it is promising in long‐term maintenance therapy. This study aims at evaluating the clinical effect of lenalidomide maintenance therapy in responding DLBCL patients with R‐CHOP treatment. METHODS: This retrospective study was devised in DLBCL cases who obtained complete response (CR) or partial response (PR) following 6–8 cycles of R‐CHOP treatment between January 1, 2015 and July 31, 2019. Patients (n = 141) included were respectively assigned to receive lenalidomide maintenance treatment (lenalidomide, n = 50) and drug‐free maintenance treatment (control, n = 91) after CR/PR. lenalidomide was provided orally at 25 mg/day for 10 days, with a cycle of 21 days and a treatment course of 2 years. Progression‐free survival (PFS) was taken as the primary outcome. RESULTS: Of the total 141 subjects, the median follow‐up time was 30.9 months (range, 5.7–68.9 months). The 2‐year PFS was 84% (95% CI: 74%–94%) in the lenalidomide group and 53% (95% CI: 43%–63%) in the control group. The median PFS of the lenalidomide group was not reached, and that of the control group was 42.9 months (HR = 0.32; 95% CI: 0.16–0.63; p = 0.001). No remarkable difference in overall survival (OS) between the two groups was indicated (HR = 0.42; 95% CI: 0.16–1.12; p = 0.08). Central nervous system (CNS) recurrence happened in 5 patients (5.5%) of the control group, while none of the patients with lenalidomide had CNS recurrence. Additionally, neutropenia and cutaneous reactions were the most common Grade 1–2 adverse reactions after lenalidomide treatment, and neutropenia was the most frequent Grade 3–4 adverse reaction. CONCLUSION: Two‐year lenalidomide maintenance treatment can significantly prolong the PFS of DLBCL patients who obtained CR/PR to first‐line R‐CHOP treatment. John Wiley and Sons Inc. 2023-03-13 /pmc/articles/PMC10225180/ /pubmed/36912128 http://dx.doi.org/10.1002/cam4.5790 Text en © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle RESEARCH ARTICLES
Wang, Xiaoyan
Yu, Lu
Jiang, Xinlu
Ding, Kaiyang
Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma
title Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma
title_full Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma
title_fullStr Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma
title_full_unstemmed Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma
title_short Real‐world data for lenalidomide maintenance in responding patients of diffuse large B‐cell lymphoma
title_sort real‐world data for lenalidomide maintenance in responding patients of diffuse large b‐cell lymphoma
topic RESEARCH ARTICLES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225180/
https://www.ncbi.nlm.nih.gov/pubmed/36912128
http://dx.doi.org/10.1002/cam4.5790
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