CLL: Maintenance Lenalidomide Has Limited Feasibility

There was no significant difference in progression-free survival between patients with relapsed/refractory chronic lymphocytic leukemia (CLL)/small lymphocytic leukemia (SLL) who received maintenance therapy after bendamustine-rituximab induction compared with no maintenance, a study published in the British Journal of Haematology has shown.¹

Although bendamustine plus rituximab has demonstrated high response rates in relapsed/refractory CLL/SLL, progression-free survival afterwards is less than 18 months. Therefore, researchers sought to determine if maintenance lenalidomide after benadmustine-rituximab induction could improve progression-free survival in this patient population.

For the study, researchers enrolled 34 patients with relapsed/refractory CLL/SLL who had received 1 to 5 prior chemotherapy regimens. Of those, 11 had confirmed presence of 17p and/or 11q deletions.

Participants received 6 cycles of bendamustine plus rituximab, and patients who achieved at least a minor response then received lenalidomide 5 to 10 mg/day for twelve 28-day cycles.

Results showed that 74% completed 6 cycles of induction therapy, and 56% achieved a response. Those patients received maintenance lenalidomide, but only 6 patients completed 12 cycles of maintenance therapy. The high discontinuation rate was primarily due to hematological and infectious toxicities.

Researchers also found that median progression-free survival was 18.3 months with maintenance therapy compared with 15.2 months without maintenance; however, the difference was not significant.

The researchers hypothesize that lenalidomide maintenance may be more feasible and effective in the first-line treatment setting, which is currently being evaluated in an ongoing trial.

Reference

1. Chang JE, Havighurst T, Kim K, et al. Bendamustine + rituximab chemoimmunotherapy and maintenance lenalidomide in relapsed, refractory chronic lymphocytic leukaemia and small lymphocytic lymphoma: a Wisconsin Oncology Network Study [published online ahead of print February 23, 2016]. Br J Haematol. doi: 10.1111/bjh.13957.