Lenalidomide for the treatment of B-cell lymphoma

Abstract

Introduction: Nearly 85% of all non-Hodgkin's lymphomas (NHLs) are derived from malignant B cells. Many of these patients are of advanced age and have concurrent comorbidities. Novel therapies utilizing unique mechanisms of action are needed to improve quality of life and overall survival in this patient population. Lenalidomide is a potent analog of the immunomodulatory drug thalidomide that exerts its effects by enhancing T-cell and NK-cell activation, decreasing angiogenesis, increasing degradation of TNF-α and downregulating NFκB.

Areas covered: A literature search was conducted using the terms ‘lenalidomide' and ‘lymphoma' on PubMed and a review of major hematology conference abstracts, posters and oral presentations held over the last 18 months was performed. There is a growing body of evidence generated from several Phase I and II studies showing antitumor activity of lenalidomide monotherapy in relapsed/refractory (R/R) patients with NHL, as well as in combination therapy in both the upfront and the R/R setting. These trials have shown promising outcomes without adding significant nonspecific toxicity.

Expert opinion: Based on current data, lenalidomide is an exciting new addition to the armamentarium against B-cell lymphomas. Although questions still remain regarding the optimal dose and schedule of lenalidomide as monotherapy and when used in combination, it will likely play an important role in improving outcomes in front-line therapy, as well as in the survival and quality of life in heavily pretreated R/R patients.

Keywords::

• B-cell lymphoma
• immunomodulatory drugs, IMiDs
• lenalidomide
• microenvironment