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Single‐agent lenalidomide in relapsed/refractory mantle cell lymphoma: results from a UK phase II study suggest activity and possible gender differences
Author(s) -
Eve Heather E.,
Carey Sean,
Richardson Sarah J.,
Heise Carla C.,
Mamidipudi Vidya,
Shi Tao,
Radford John A.,
Auer Rebecca L.,
Bullard Sheila H.,
Rule Simon A. J.
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.12008
Subject(s) - lenalidomide , mantle cell lymphoma , medicine , thalidomide , gastroenterology , refractory (planetary science) , phases of clinical research , confidence interval , oncology , lymphoma , chemotherapy , multiple myeloma , biology , astrobiology
Summary We present data from a phase II study investigating a novel treatment strategy for relapsed/refractory mantle cell lymphoma ( MCL ). Twenty‐six patients received lenalidomide 25 mg/d (days 1–21 of a 28‐d cycle) for up to 6 cycles followed by low‐dose maintenance lenalidomide (15 mg) in responding patients. Eight patients achieved complete or partial response to give an overall response rate of 31% with median response duration of 22·2 months [95% confidence interval ( CI ) 0·0–53·6] and median progression‐free survival ( PFS ) of 3·9 months (95% CI 0·0–11·1). An additional six patients (23%) achieved stable disease. Eleven patients received maintenance with median PFS of 14·6 months (95% CI 7·3–21·9). Correlative studies showed that peripheral T and N atural K iller ( NK ) cells increased in responding patients by 40–60% over the first 6 cycles with an initial dip in NK cells suggestive of tumour infiltration. Peripheral regulatory T cells were increased in MCL patients ( P = 0·001) and expanded further following lenalidomide. Sequential plasma analysis showed increased IL 12 p40 and IL 7 alongside decreased MMP 9, IL 10, and adiponectin. Finally, a significant correlation ( P = 0·02) between gender and response suggested that female MCL patients were more sensitive to lenalidomide than males. In summary, we confirm the activity, safety and immunomodulatory properties of lenalidomide in MCL and highlight its potential as a low‐dose maintenance agent.