Lenalidomide induces long-lasting responses in elderly patients with chronic lymphocytic leukemia

Abstract

We evaluated long-term outcomes of 60 patients with chronic lymphocytic leukemia treated with an initial therapy of lenalidomide. At a median follow-up of 4 years, time-to-treatment failure has not been reached and overall survival is 82%. Thirty-five (58%) patients had a response lasting >36 months (long-term responders [LTRs]). Best LTR responses consisted of 25 (71%) complete remissions and 10 (29%) partial remissions. In addition to clinical responses, an increase in IgA, IgG, and IgM levels of >50% from baseline was reported in 61%, 45%, and 42% of LTRs. Normalization in the percentage of CD4+ and CD8+ cells and T-cell numbers was observed in 48%, 71% and 99% of LTRs. Compared with other patients in the study, LTRs had lower baseline plasma levels of β-2-microglobulin, were more likely to have trisomy 12, and less likely to have deletion 17p.

Trial registration: ClinicalTrials.gov NCT00535873.

Figures

Figure 1

Changes in T-cell numbers and plasma immunoglobulin levels during therapy with lenalidomide. (A) Peripheral CD3+ T-cell numbers (mean values ± 1 standard deviation) measured at baseline and during treatment with lenalidomide in 31 LTRs. (B) Percentages of CD4 and CD8+ measured at baseline and during treatment with lenalidomide in 31 LTRs. Baseline median absolute value of CD4 and CD8 was 271 and 176 × 103/mL, respectively, and after 60 months increased to 456 and 362 × 103/mL, respectively. (C) Increase in plasma immunoglobulin measured in 31 LTRs during treatment with lenalidomide when compared with baseline (P < .001) . Values are expressed as percentage change from baseline, mean values ± 1 standard deviation. Median baseline were IgG, 729 (180-3560) mg/dL; IgA, 91 (15-223) mg/dL; and IgM, 27 (0-485) mg/dL. Baseline IgG, IgA, and IgM levels were less than the normal range in 15 (43%), 14 (40%), and 22 (63%) LTRs, and later normalized in 58%, 57%, and 45% of them, respectively.