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Chronic lymphocytic leukemia

Sustained long-lasting responses after lenalidomide discontinuation in patients with chronic lymphocytic leukemia

Leukemia volume 32, pages 2278–2281 (2018)Cite this article

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Toxicity prompting treatment discontinuation remains a major challenge in the management of chronic lymphocytic leukemia (CLL), both with chemoimmunotherapy and with novel biological agents [1,2,3]. Toxicity-related treatment discontinuation was reported in up to 60% of CLL patients treated with the combination of fludarabine, cyclophosphamide, and rituximab [4, 5]. In patients treated with chemoimmunotherapy, treatment discontinuation can result in lower response rates and shorter time to next treatment (TTNT) [6]. Toxicity-related treatment discontinuation has been reported in about 10 to 20% of CLL patients treated with ibrutinib [7] and up to 40% of those treated with idelalisib plus rituximab [8]; typically, following discontinuation, the disease rapidly progresses with aggressive biological and clinical features and an overall unfavorable outcome [7, 8].

Lenalidomide is an immunomodulatory agent with well-established clinical benefits in CLL [9]. Unfortunately, its development has been slowed by the results of a phase III front-line clinical trial comparing single-agent lenalidomide with single-agent chlorambucil in elderly patients with CLL, which was stopped early because of higher rate of toxicity-related deaths in the lenalidomide arm [10].

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Acknowledgements

We thank Stephanie P Deming, Senior Scientific Editor, for revising the grammatical and stylistic correctness of this manuscript. This research is supported in part by the MD Anderson Cancer Center Support Grant P30 CA016672.

Author contributions

Z.E. designed, performed, and analyzed the study, provided clinical care to patients, and wrote the paper; P.S. analyzed data, performed statistical analysis, and wrote the paper; A.F., W.G.W., N.J., P.A.T., S.M.O., H.K., J.A.B., C.H., K.R. and M.J.K. provided clinical care to patients and coauthored the paper.

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Authors and Affiliations

  1. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Paolo Strati, Alessandra Ferrajoli, William G. Wierda, Nitin Jain, Philip A. Thompson, Susan M. O’Brien, Katy Rezvani, Hagop M. Kantarjian, Jan A. Burger, Christina O. Hinojosa, Michael J. Keating & Zeev Estrov

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  1. Paolo Strati
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Correspondence to Zeev Estrov.

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Conflict of interest

M.J.K. was a consultant for Celgene Corporation; W.G.W. was a consultant/advisory board member for Celgene Corporation; S.M.O. was a consultant for Celgene Corporation; and A.F. received research support from Celgene Corporation. The remaining authors declare no competing financial interests.

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Strati, P., Ferrajoli, A., Wierda, W.G. et al. Sustained long-lasting responses after lenalidomide discontinuation in patients with chronic lymphocytic leukemia. Leukemia 32, 2278–2281 (2018). https://doi.org/10.1038/s41375-018-0059-3

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