Lenalidomide: what is the right dose in CLL?

摘要

The immunomodulating drug lenalidomide is approved for treatment of multiple myeloma (MM) and 5q- myelodysplastic syndrome (MDS). However, its mechanism of action remains unclear and may be disease specific. The maximal tolerated dose was 25 mg daily in MM, but 10 mg daily was as effective as, and caused less hematologic toxi-city than, 25 mg daily in MDS. Thus, lena-lidomide's tolerability and optimal dose, like its mechanism of action, may be disease specific.Chanan-Khan and colleagues administered lenalidomide at a dose of 25 mg daily on days 1 to 21 every 28 days to 45 patients with relapsed chronic lymphocytic leukemia (CLL).3 Lenalidomide was active (overall response rate [ORR] 47%, complete remission [CR] 9%), although hematologic toxicity at grades 3 and 4 was significant, and 2 patients developed tumor lysis syndrome. Furthermore, 58% of patients experienced a unique tumor flare reaction, occurring within 24 hours of the first dose and lasting a median of 14 days, which was not observed in MM or MDS