A trial looking at lenalidomide for diffuse large B cell lymphoma

Cancer type:

High grade lymphoma

Lymphoma

Non-Hodgkin lymphoma

Status:

Results

Phase:

Phase 2/3

This trial looked at lenalidomide for diffuse large B cell lymphoma that has continued to grow during treatment, or come back after treatment.

More about this trial

Diffuse large B cell lymphoma (DLBCL) is one of the most common types of high grade non Hodgkin lymphoma. When this trial was done, doctors commonly used a combination of chemotherapy and a drug called rituximab. This combination is called R-CHOP.

If the lymphoma does not go away, or comes back after treatment, doctors may use other chemotherapy drugs to treat DLBCL.

Lenalidomide (Revlimid) is a treatment that affects how the immune system works. The researchers wanted to find out if lenalidomide may be useful to treat DLBCL.

We already knew from research that there are 2 distinct sub types of DLBCL. They are called:

germinal center B cell (GCB) lymphoma
non germinal center B cell (non GCB) lymphoma

The research team analysed the lymphoma cells of the people who took part in this trial to see which type they had. They then compared how well treatment worked for people in each group.

The aims of this trial were to:

compare lenalidomide with the chemotherapy drugs already used
see if there was difference between how well treatment worked for GCB and non GCB lymphoma

Summary of results

This trial showed that lenalidomide did work for people with diffuse large B cell lymphoma. They found it worked better for people non GCB lymphoma.

This trial was open for people to join between 2010 and 2013, and the research team published the results in 2017.

Results

Just over 100 people with diffuse large B cell lymphoma (DLBCL) had treatment as part of this trial. They had already had other treatment, but either it hadn’t worked or their lymphoma had come back.

The people taking part were put into 1 of 2 groups at random, and:

51 had lenalidomide
51 had the chemotherapy their doctor thought was best for them (standard treatment)

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Just under half the people in each group had germinal center B cell (GCB) lymphoma. And just over half had non germinal center B cell (non GCB) lymphoma.

How well treatment worked

The research team looked at how many people’s lymphoma either went away or got a bit better, and found it was:

8 people (29%) who had lenalidomide for non GCB lymphoma
3 people (12%) who had standard treatment for non GCB lymphoma
6 people (26%) who had lenalidomide for GCB lymphoma
3 people (12%) who had standard treatment for GCB lymphoma

They also looked at how long it was before the lymphoma started to grow again. When they looked at people with non GCB lymphoma they found it was:

15 weeks for those who had lenalidomide
7 weeks for those who had standard treatment

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And when they looked at people with GCB lymphoma they found it was:

10 weeks for those who had lenalidomide
9 weeks for those who had standard treatment

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They also looked at how long people lived. It was:

33 weeks for those who had lenalidomide for non GCB lymphoma
20 weeks for those who had had standard treatment for non GCB lymphoma
30 weeks for those who had lenalidomide for GCB lymphoma
25 weeks for those who had standard treatment for GCB lymphoma

The research team also looked at the genes in the lymphoma cells of some of the people who took part, after they’d had treatment. They found that lenalidomide had worked better for people with activated B cell like (ABC) lymphoma. But more research needs to be done in this area.

Side effects
Everyone taking part had a least 1 side effect. Some were mild, but just over half the people in each group had a side effect that was serious.

The most common side effects of standard treatment included:

feeling sick (nausea)
tiredness (fatigue)
a drop in white blood cells, red blood cells and clotting cells (platelets)

The most common side effects of lenalidomide included:

tiredness (fatigue)
constipation
diarrhoea
a drop in white blood cells, red blood cells and clotting cells (platelets)
rash

Conclusion
The research team concluded that lenalidomide worked for both types of DLBCL, but worked better for non germinal center B cell (non GCB) lymphoma.

They recommend that other trials are done to find out more about how well it works for the different genetic sub groups.

Where this information comes from
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.