Tumor flare reaction associated with lenalidomide treatment in patients with chronic lymphocytic leukemia predicts clinical response

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Blank Tumor flare reaction associated with lenalidomide treatment in patients

with chronic lymphocytic leukemia predicts clinical response.

A Chanan-Khan, KC , D Lawrence, S Padmanabhan, A , F

-Illatazurri, MS Czuczman, PK Wallace, JB Zeldis, and K Lee

Cancer, November 29, 2010; .

Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.

BACKGROUND:: In patients with chronic lymphocytic leukemia (CLL), treatment with

lenalidomide induces a unique, previously uncharacterized, immune response

called tumor flare reaction (TFR). The clinical significance of this reaction

remains unknown. METHODS:: Forty-five patients with CLL who were treated with

lenalidomide in a phase 2 clinical trial were evaluated for the clinical

features, intensity, and duration of TFR. Correlation was made with tumor

response and the immune cellular microenvironment. Steroids for the prophylaxis

of TFR was not given to patients in Group A (n = 29) whereas patients in Group B

(n = 16) received low-dose prednisone as well as a slow dose escalation of

lenalidomide for the prevention of TFR. RESULTS:: Thirty (67%) patients

experienced a TFR, with a grade 2 or 3 reaction (according to National Cancer

Institute Common Toxicity Criteria [version 3.0]) observed in 33% of patients

(47% in Group A and 9% in Group B; P = .05). The median time to onset of the TFR

was 6 days, and was longer in the patients receiving prophylaxis (4 days vs 9

days, respectively; P = .01). A complete response was observed in 7 of 30 (23%)

patients with TFR and 1 of 15 (7%) patients without TFR. The median

progression-free survival was 19.9 months and 19.4 months, respectively, for

patients with versus those without TFR (P = .92). CONCLUSIONS:: TFR is a unique

immune-mediated phenomenon noted with lenalidomide treatment only in patients

with CLL that correlates with clinical response. It can be effectively managed

with anti-inflammatory agents. Cancer 2010. ? 2010 American Cancer Society.

PMID: 21117186