Lenalidomide for mantle cell lymphoma

Abstract

Mantle cell lymphoma accounts for 6% of all non-Hodgkin lymphomas. It is a biologically and clinically heterogeneous disease and treatment may be difficult, since most patients present at an older age, being unable to undergo intensive chemotherapy. Lenalidomide is an approved medication for relapsed mantle cell lymphoma in patients who received at least two lines of therapy, including bortezomib. New insights into the mechanisms of action of lenalidomide provided ground for novel combinations that may be more tolerable, while still efficient, for this patient population. In this review, we evaluate the current paradigm for lenalidomide in mantle cell lymphoma.

Keywords:

• IMiD
• immunomodulatory
• lenalidomide
• mantle cell lymphoma
• revlimid

Financial & competing interests disclosure

A Skarbnik is on the speaker bureau for Genentech and Gilead Sciences. A Goy has provided consultancy for Celgene and has received honoraria from Celgene and is on the speaker’s bureau for Millenium, Janssen and Pharmacyclics. A Goy is an advisory board member for Janssen, Pharmacuclics, Celgene, Millenium and has received research funding from Pharmacyclics, Janssen, Celgene and Millenium. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Lenalidomide is an active agent against mantle cell lymphoma (MCL). It has varied mechanisms of action, but seemingly, the most important one is through the restoration of T-cell immunological synapses.

• Lenalidomide is an approved agent for patients with MCL whose disease relapsed after two previous therapies, one of which must have included bortezomib.

• New data point to exciting outcomes when lenalidomide is combined with other agents in the frontline setting, more specifically with rituximab, and with bendamustine and rituximab.

• There is a potential to develop non-chemotherapy options for patients with MCL, which should include lenalidomide.

• Further insights into the mechanisms of resistance to lenalidomide are needed to expand the use of this drug in the MCL patient population.