Prolonged follow‐up on lenalidomide‐based treatment for mucosa‐associated lymphoid tissue lymphoma (MALT lymphoma)—Real‐world data from the Medical University of Vienna

• Published in: Hematological oncology Vol. 37; no. 4; pp. 345 - 351
• Main Authors: Kiesewetter, Barbara, Lamm, Wolfgang, Neuper, Ortrun, Mayerhoefer, Marius E., Simonitsch‐Klupp, Ingrid, Raderer, Markus
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2019; John Wiley and Sons Inc
• Subjects: Adult; Aged; Aged, 80 and over; Angiogenesis Inhibitors - administration & dosage; Angiogenesis Inhibitors - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Austria - epidemiology; Clinical trials; Disease control; Drug Evaluation; extranodal lymphoma; Female; Follow-Up Studies; Health services; Humans; IMiD; Immunologic Factors - administration & dosage; Immunologic Factors - therapeutic use; immunomodulatory treatment; Immunotherapy; Kaplan-Meier Estimate; lenalidomide; Lenalidomide - administration & dosage; Lenalidomide - therapeutic use; Lymphoid tissue; Lymphoma; Lymphoma, B-Cell, Marginal Zone - drug therapy; Lymphoma, B-Cell, Marginal Zone - epidemiology; Male; Malt; MALT lymphoma; Medical treatment; Middle Aged; Monoclonal antibodies; Mucosa; Mucosal-associated lymphoid tissue; Neoplasm Metastasis; Neoplasm Recurrence, Local - epidemiology; Original; Original s; Patients; Progression-Free Survival; Remission; Remission Induction; Retrospective Studies; Rituximab; Subgroups; Survival; Targeted cancer therapy; Treatment Outcome; Austria; MALT lymphoma; lenalidomide; IMiD; extranodal lymphoma; immunomodulatory treatment
• ISSN: 0278-0232; 1099-1069
• DOI: 10.1002/hon.2647

Based on results of two pilot trials, lenalidomide (LEN) was found to be active and safe as monotherapy and showed an increased response rate of 80% in combination with rituximab (R) for patients with mucosa‐associated lymphoid tissue (MALT) lymphoma. While initial results were promising, there are currently no data on long‐term outcome, and larger international phase II/III trials on LEN for indolent lymphoma lack specific subgroup analyses. Thus, we have systematically analyzed 50 patients treated with LEN‐based therapy (LEN‐monotherapy n = 16, R‐LEN n = 34) at the Medical University of Vienna 2009 to 2019 and investigated long‐term outcome and relapse patterns. At a follow‐up of more than 5 years (median 68 months), 54% of patients are free of relapse, and estimated median progression‐free survival (PFS) was 72 months (95%CI 49‐96). There was no difference in PFS according to stage of disease, i.e. localized versus disseminated disease (P = .67) and previous systemic treatment (P = .16). Interestingly, but with the caveat of the limited number of patients included in this series, primary extragastric disease had a superior PFS compared with gastric lymphoma (P = .04) and also depth of response, i.e. complete or partial response versus stable disease was associated with significantly prolonged PFS (P = .01). We documented four patients (8%) with pronounced improvement of response during follow‐up including three patients initially rated as partial remission and finally achieving complete remission at 12 to 32 months. This highlights the potential of delayed responses to LEN treatment. Estimated overall survival at 5 years was excellent at 92%. These “real‐world” data confirm long‐term activity of LEN in MALT lymphoma.