Abstract
Lenalidomide is an oral immunomodulatory agent approved in relapsed multiple myeloma with dexamethasone, for transfusion-dependent anemia in myelodysplastic syndrome associated with deletion 5q, and in relapsed/progressive mantle cell lymphoma following bortezomib. In recent clinical trials, lenalidomide has shown promising activity in hematologic malignancies, including chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL). Starting doses and dosing schedules vary by malignancy, with lenalidomide started at a lower dose for CLL than for NHL or multiple myeloma. Certain adverse events (AEs) are common across tumor types (e.g., neutropenia, thrombocytopenia, fatigue), whereas others are more often associated with CLL patients (e.g., tumor lysis syndrome and tumor flare reaction). Effective management requires awareness of these differences as well as appropriate prophylaxis, monitoring, and treatment of AEs. This article reviews the efficacy and safety of lenalidomide in CLL and NHL, focusing on approaches for the advanced practitioner to improve patient quality of life through optimal management of side effects. With these steps, lenalidomide can be administered safely, at the best starting doses and with minimal dose interruptions or reductions across hematologic malignancies.
Highlights
Lenalidomide (Revlimid) is an oral immunomodulatory agent approved in the United States in combination with dexamethasone for patients with multiple myeloma (MM) who have received one or more prior therapies and as a single agent for transfusion-dependent anemia due to low-/intermediate-1–risk myelodysplastic syndrome (MDS) associated with deletion 5q with/without additional cytogenetic abnormalities (Dimopoulos et al, 2007; Celgene, 2013; Weber et al, 2007)
Tumor flare reaction usually occurs during the first treatment cycle, with a median time to onset of 6 days and a median time to resolution of 14 days, and the intensity of tumor flare reactions (TFRs) may be positively correlated with achieving a CR with lenalidomide in chronic lymphocytic leukemia (CLL) patients (ChananKhan et al, 2011)
Recent clinical trials support the activity of lenalidomide in lymphoid malignancies, including CLL and non-Hodgkin lymphoma (NHL), and show that dose levels and certain toxicities differ across cancer types
Summary
D. Anderson Cancer Center (MDACC) focused on lenalidomide dose optimization in heavily pretreated patients with relapsed/refractory CLL for maximal activity without compromising safety (Chanan-Khan et al, 2006; Ferrajoli et al, 2008). Lenalidomide produced overall response rates (ORR) of 47% (21/45 patients, 9% complete response [CR], RPCI; Chanan-Khan et al, 2006) and 32% (14/44 patients, 7% CR, MDACC; Ferrajoli et al, 2008). Grade 3/4 adverse events (AEs) were mainly hematologic, and included neutropenia (70% patients [RPCI], 41% of treatment courses [MDACC]) and thrombocytopenia (45% of patients and 15% of treatment courses, respectively). Diarrhea, rash, and tumor flare reactions (TFRs) were common nonhematologic AEs, they were mostly grade 1/2 (ChananKhan et al, 2006; Ferrajoli et al, 2008)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
