Lenalidomide may boost prognosis in diffuse large B-cell lymphoma

1. The addition of lenalidomide to standard R-CHOP chemotherapy reduced the negative prognostic impact of non-GCB phenotype in diffuse large B-cell lymphoma (DLBCL) progression-free and overall survival.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Therapy for diffuse large B-cell lymphoma (DLBCL) has advanced in recent years with the introduction of dose-intensified cytotoxic therapies as well as rituximab. There are two major subtypes of DLBCL: germinal center B-cell-like (GCB) and activated B-cell-like (ABC) or non-germinal center B-cell (non-GCB). Patients with the latter genotype have significantly worse outcomes on the standard chemotherapy combination of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone (R-CHOP) therapy. The purpose of this study was to further evaluate the effect of adding lenalidomide to R-CHOP (R2CHOP) on survival outcomes in DLBCL. At the conclusion of this phase II clinical trial, the authors found that 24 month progression-free and overall survival did not differ significantly between GCB and non-GCB patients on R2CHOP., indicating a potential benefit of lenalidomide. The results of this trial demonstrate the potential a benefit of R2CHOP in the non-GCB phenotype; however, the trial had a small sample size of patients and additional clinical trials are recommended to validate these results.

Click to read the study in JCO

Relevant Reading: CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with Diffuse Large-B-Cell Lymphoma

In-Depth [open-labeled clinical trial]: This phase II clinical trial included 64 patients with diffuse large B-cell lymphoma (DLBCL). Patients received lenalidomide daily for the first 10 days of standard dose R-CHOP for six cycles. Tumor immunohistochemistry was used to determined DLBCL molecular subtype to classify germinal center B-cell (GCB) versus non-GCB. The study authors selected 87 control patients with DLBCL treated with conventional R-CHOP alone from the Mayo Clinic Lymphoma Database. Overall, 98% of patients on R2CHOP achieved complete response to treatment. Event-free and overall survival at 2 years was 59% (95% CI: 48-74%) and 78% (95% CI: 68-90%), respectively. In R-CHOP only patients, progression-free and overall survival were 28% versus 64% (p < 0.001) and 46% versus 78% (p <0.001) in non-GCB versus GCB DLBCL. In R2CHOP patients, there was no difference in 2 year PFS or OS (p = 0.83 and p = 0.61) based on GCB status.

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Image: PD 

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