DLBCL: maintenance lenalidomide improves PFS without affecting QoL

  • Thieblemont C & al.
  • Br J Haematol
  • 8 Nov 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Key takeaway

  • In older patients with diffuse large B-cell lymphoma (DLBCL), maintenance lenalidomide after response to R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) delivered significant improvement in PFS with no meaningful effect on health-related QoL (HRQOL).

Why this matters

  • The REMARC study demonstrated significant PFS improvement with maintenance lenalidomide vs placebo:
    • Median PFS: not reached vs 58.9 months (HR, 0.708; 95% CI, 0.54-0.93; P=.01).

Study design

  • Subpopulation analysis to investigate effects of lenalidomide maintenance (n=229) vs placebo (n=228) on HRQOL in patients with DLBCL aged ≥60 years from the REMARC study.
  • Funding: Lymphoma Academic Research Organisation of France; Celgene Corporation.

Key results

  • Global health status (GHS) was comparable between treatment groups throughout maintenance.
  • Rates of observable treatment-emergent adverse events (TEAEs); rates of TEAEs leading to dose reduction:
    • Lenalidomide group: 81.1%; 54.3%.
    • Placebo group: 63.3%; 22.6%.
  • HR for PFS for lenalidomide vs placebo:
    • In 366 patients who received dose reduction: 0.795 (95% CI, 0.531-1.190; P=.2632).
    • In 279 patients who did not receive dose reduction: 0.788 (95% CI, 0.515-1.205; P=.2694).
    • No significant difference in treatment benefit regardless of dose reduction: 1.353 (P=.2978).

Limitations

  • Post hoc analysis.