A phase 2 study of lenalidomide, rituximab, cyclophosphamide, and dexamethasone (LR-CD) for untreated low-grade non-Hodgkin lymphoma requiring therapy

Allison Rosenthal, Amylou Dueck, Stephen Maxted Ansell, Katherine Gano, Christopher Conley, Grzegorz S Nowakowski, John K Camoriano, Jose F. Leis, Joseph R Mikhael, Alexander Keith Stewart, David Inwards, David M Dingli, Shaji K Kumar, Pierre Noel, Morie Gertz, Luis Porrata, Stephen J Russell, Joseph Colgan, Rafael Fonseca, Thomas Matthew HabermannPrashant Kapoor, Francis Buadi, Nelson Leung, Rodger Tiedemann, Thomas Elmer Witzig, Craig Reeder

Research output: Contribution to journalArticle

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Abstract

Patients with indolent non-Hodgkin lymphoma (NHL) have multiple treatment options yet there is no consensus as to the best initial therapy. Lenalidomide, an immunomodulatory agent, has single agent activity in relapsed lymphoma. This trial was conducted to assess feasibility, efficacy, and safety of adding lenalidomide to rituximab, cyclophosphamide, and dexamethasone (LR-CD) in untreated indolent NHL patients requiring therapy. This was a single institution phase II trial. Treatment consisted of IV rituximab 375 mg/m2 day 1; oral lenalidomide 20 mg days 1–21; cyclophosphamide 250 mg/m2 days 1, 8, and 15; and dexamethasone 40 mg days 1, 8, 15, and 22 of a 28-day cycle. Treatment continued 2 cycles beyond best response for a maximum of 12 cycles without rituximab maintenance. Thirty-three patients were treated. Median age was 68 (43–83 years). 39% had stage IV disease. Histologic subtypes included 8 follicular lymphoma (FL), 7 marginal zone lymphoma (MZL) (1 splenic, 2 extranodal, and 4 nodal), 15 Waldenström's macroglobulinemia (WM), 1 lymphoplasmacytic lymphoma, 1 small lymphocytic lymphoma, and 1 low-grade B-cell lymphoma with plasmacytic differentiation (unable to be classified better as MZL or LPL). Hematologic toxicity was the most common adverse event. Median time of follow-up was 23.4 months (range 1.8–50.9). The overall response rate was 87.9%, with 30.3% complete response. The median duration of response was 38.7 months. The median progression free survival was 39.7 months, while median overall survival (OS) has not yet been reached. Lenalidomide can be safely added to a simple regimen of rituximab, oral cyclophosphamide, and dexamethasone and is an effective combination as initial therapy for low-grade B-cell NHL.

Original languageEnglish (US)
Pages (from-to)467-472
Number of pages6
JournalAmerican Journal of Hematology
Volume92
Issue number5
DOIs
StatePublished - May 1 2017

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Non-Hodgkin's Lymphoma
Cyclophosphamide
Dexamethasone
Lymphoma
B-Cell Lymphoma
Therapeutics
Waldenstrom Macroglobulinemia
Follicular Lymphoma
B-Cell Chronic Lymphocytic Leukemia
Disease-Free Survival
lenalidomide
Rituximab
Maintenance
Safety
Survival

ASJC Scopus subject areas

  • Hematology

Cite this

A phase 2 study of lenalidomide, rituximab, cyclophosphamide, and dexamethasone (LR-CD) for untreated low-grade non-Hodgkin lymphoma requiring therapy. / Rosenthal, Allison; Dueck, Amylou; Ansell, Stephen Maxted; Gano, Katherine; Conley, Christopher; Nowakowski, Grzegorz S; Camoriano, John K; Leis, Jose F.; Mikhael, Joseph R; Stewart, Alexander Keith; Inwards, David; Dingli, David M; Kumar, Shaji K; Noel, Pierre; Gertz, Morie; Porrata, Luis; Russell, Stephen J; Colgan, Joseph; Fonseca, Rafael; Habermann, Thomas Matthew; Kapoor, Prashant; Buadi, Francis; Leung, Nelson; Tiedemann, Rodger; Witzig, Thomas Elmer; Reeder, Craig.

In: American Journal of Hematology, Vol. 92, No. 5, 01.05.2017, p. 467-472.

Research output: Contribution to journalArticle

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abstract = "Patients with indolent non-Hodgkin lymphoma (NHL) have multiple treatment options yet there is no consensus as to the best initial therapy. Lenalidomide, an immunomodulatory agent, has single agent activity in relapsed lymphoma. This trial was conducted to assess feasibility, efficacy, and safety of adding lenalidomide to rituximab, cyclophosphamide, and dexamethasone (LR-CD) in untreated indolent NHL patients requiring therapy. This was a single institution phase II trial. Treatment consisted of IV rituximab 375 mg/m2 day 1; oral lenalidomide 20 mg days 1–21; cyclophosphamide 250 mg/m2 days 1, 8, and 15; and dexamethasone 40 mg days 1, 8, 15, and 22 of a 28-day cycle. Treatment continued 2 cycles beyond best response for a maximum of 12 cycles without rituximab maintenance. Thirty-three patients were treated. Median age was 68 (43–83 years). 39{\%} had stage IV disease. Histologic subtypes included 8 follicular lymphoma (FL), 7 marginal zone lymphoma (MZL) (1 splenic, 2 extranodal, and 4 nodal), 15 Waldenstr{\"o}m's macroglobulinemia (WM), 1 lymphoplasmacytic lymphoma, 1 small lymphocytic lymphoma, and 1 low-grade B-cell lymphoma with plasmacytic differentiation (unable to be classified better as MZL or LPL). Hematologic toxicity was the most common adverse event. Median time of follow-up was 23.4 months (range 1.8–50.9). The overall response rate was 87.9{\%}, with 30.3{\%} complete response. The median duration of response was 38.7 months. The median progression free survival was 39.7 months, while median overall survival (OS) has not yet been reached. Lenalidomide can be safely added to a simple regimen of rituximab, oral cyclophosphamide, and dexamethasone and is an effective combination as initial therapy for low-grade B-cell NHL.",
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AU - Gano, Katherine

AU - Conley, Christopher

AU - Nowakowski, Grzegorz S

AU - Camoriano, John K

AU - Leis, Jose F.

AU - Mikhael, Joseph R

AU - Stewart, Alexander Keith

AU - Inwards, David

AU - Dingli, David M

AU - Kumar, Shaji K

AU - Noel, Pierre

AU - Gertz, Morie

AU - Porrata, Luis

AU - Russell, Stephen J

AU - Colgan, Joseph

AU - Fonseca, Rafael

AU - Habermann, Thomas Matthew

AU - Kapoor, Prashant

AU - Buadi, Francis

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AU - Witzig, Thomas Elmer

AU - Reeder, Craig

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