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Rituximab and lenalidomide for the treatment of relapsed or refractory indolent non-Hodgkin lymphoma: real-life experience
Open accessAbstract
The combination of rituximab and lenalidomide (R-len) stands as an established treatment for relapsed/refractory (R/R) indolent non-Hodgkin lymphoma (iNHL). However, the reproducibility of clinical trial results in routine clinical practice is unknown. To address this gap in knowledge, we reviewed our experience with patients diagnosed with R/R follicular lymphoma (FL) or marginal zone lymphoma (MZL) treated with this combination. Eighty-four patients underwent treatment with R-len, 69 (82%) affected by FL and 15 (18%) by MZL. The median age at the time of treatment initiation was 65 years (range, 39-94), 38 patients (45%) had a pretreatment FLIPI score of 3-5, 19 (23%) had a bulky disease, 29 (37%) had a lymphoma refractory to the last treatment line, while in 20 (24%) cases the disease was refractory to rituximab. The best overall response rate was 82%, and 52% achieved a complete response (CR). The best CR rates for FL and MZL patients were 55% and 40%, respectively. With a median follow-up of 22 months, the median progression- free survival was 22 months (95% confidence interval [CI]: 19-36) and the 2-year overall survival was 83% (95% CI: 74-93). The median duration of CR was 46 months (95% CI: 22-not reached). Factors associated with shorter progression-free survival in multivariate analysis were bulky disease and rituximab refractoriness. The most common adverse events included hematologic toxicity, fatigue and gastrointestinal disorders, such as diarrhea and constipation. Neutropenia and thrombocytopenia were the most common severe toxicities (grade ≥3 in 25% and 4%, respectively). No new safety signals were reported. Real-life results of R-len in patients with R/R iNHL appear consistent with those reported in prospective studies, and further support its use as comparator arm in controlled clinical trials.
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“However, only about half of participants had a complete response with R² in clinical trials. 5,8”
From Epcoritamab, lenalidomide, and rituximab versus lenalidomide and rituximab for relapsed or refractory follicular lymphoma (EPCORE FL-1): a global, open-label, randomised, phase 3 trial. (2026) · cites this paper as [8]
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Falchi, L., Nijland, M., Huang, H., Linton, K. M., Seymour, J. F., Tao, R., Kwiatek, M., Costa, A., Vassilakopoulos, T. P., Greil, R., et al. (2026) · The Lancet · doi:10.1016/s0140-6736(25)02360-8 · Cited by 41
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Metadata
- Authors
- Cassanello, G., Drill, E., Rivas-Delgado, A., Okwali, M., Isgor, I., Caron, P. C., Epstein-Peterson, Z., Ghione, P., Hamlin, P., Lue, J., Horwitz, S. M., Intlekofer, A. M., Johnson, W., Kumar, A., Moskowitz, A., Noy, A., Owens, C., Palomba, L. M., Torka, P., Galera, P., Zelenetz, A. D., Salles, G., & Falchi, L.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Corresponding author
- Falchi, Lorenzo
- ORCID
- Venue
- Haematologica
- Published
- 2024-09-05
- Volume
- 110
- Issue
- 2
- Pages
- 439-447
- ISSN
- 0390-6078 (ISSN-L)
- 1592-8721
- PMC
- PMC11788635
- OpenAlex
- W4402259557
- Cited by
- 3
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Haematologica (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Health Sciences › Medicine › Hematology › Chronic Lymphocytic Leukemia Research
- Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
- Keywords
- rituximab, lenalidomide, follicular lymphoma, marginal zone lymphoma, real-world outcomes, progression-free survival, complete response, bulky disease, hematologic toxicity, neutropenia, thrombocytopenia
- MeSH terms
- Rituximab, Lenalidomide, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols, Female, Humans, Lymphoma, Follicular, Lymphoma, Non-Hodgkin, Male, Middle Aged, Recurrence, Retrospective Studies, Treatment Outcome, Drug Resistance, Neoplasm
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