According to the results of two studies presented at the 2008 annual meeting of the American Society of Hematology (ASH), Revlimid® (lenalidomide) appears to be effective for the initial treatment of patients with symptomatic chronic lymphocytic leukemia (CLL).

CLL is the most common adult leukemia with over 15,000 new cases per year in the United States and almost 5,000 deaths. CLL is not a rapidly growing cancer, but the abnormal cells accumulate in blood, bone marrow, lymph nodes, and spleen, resulting in enlargement of these organs and decreased bone marrow and immune function. This disease interferes with the normal production of antibodies and immunoglobulins, so the body cannot properly fight infections.

Revlimid, an immunomodulatory agent, fights cancer through several biological mechanisms, many of which are still being evaluated. One action Revlimid uses against cancer is to prevent or reduce blood vessel growth to the cancer. This ultimately “starves” the cancer cells of nutrients and oxygen. Revlimid continues to be evaluated in clinical trials for various types of cancers. In a previous study, Revlimid produced an overall response rate of 47% among patients with refractory CLL.[[1]]( "_ednref1")

At the 2008 ASH meeting, researchers from Canada reported results of treatment with Revlimid among 25 newly diagnosed patients with symptomatic CLL.[[2]]( "_ednref2") The partial remission rate was 65%, with 35% having stable disease. These researchers suggest that low-dose Revlimid is effective therapy for newly diagnosed CLL. Researchers from the M. D. Anderson Cancer Center presented data on treating 35 newly diagnosed elderly patients with CLL.[[3]]( "_ednref3") The median age of patients in this study was 72 years. Fifty-four percent had a partial response and 40% had stable disease. These researchers suggest that low-dose Revlimid is safe and well tolerated as initial treatment of CLL in the elderly.

These data suggest significant activity of Revlimid in newly diagnosed patients with CLL. However, it is not clear that there are any advantages to this approach over treatment with Rituxan® (rituximab) and steroids, which is also effective, non-toxic initial therapy of CLL. Thus, the timing of Revlimid use remains to be determined in patients with CLL.

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[[1]]( "_edn1") Chanan-Khan A, Miller KC, Musial L, et al. Clinical efficacy of lenalidomide in patients with relapsed or refractory chronic lymphocytic leukemia: results of a phase II study. Journal of Clinical Oncology. 2006;24:5343-5349.

[[2]]( "_edn2") Chen C, Paul H, Xu W, et al. A phase II study of lenalidomide in previously untreated, symptomatic chronic lymphocytic leukemia (CLL). Blood. 2008;112:23, abstract number 44.

[[3]]( "_edn3") Ferrajoli A, O”Brien S, Wierda W, et al. Lenalidomide as initial treatment of elderly patients with chronic lymphocytic leukemia (CLL). Blood. 2008;112:23, abstract number 45.

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