Thalidomide, lenalidomide and rituximab have no direct effect on MCL cells. However, both indirectly affect peripheral blood mononuclear cell-mediated cytotoxicity, and rituximab induces both complement-dependent and antibody-dependent cellular cytotoxicity (ADCC) against MCL cells. Rituximab-induced ADCC is enhanced by lenalidomide and thalidomide. In a 2004 series, thirteen patients of sixteen enrolled (81%) experienced an objective response, with 5 complete responders (31%). Median progression-free survival (PFS) was 20.4 months (95% confidence interval [CI], 17.3-23.6 months), and estimated 3-year survival was 75%. In patients achieving a complete response, PFS after rituximab plus thalidomide was longer than PFS after the preceding chemotherapy. Severe adverse events included 2 thromboembolic events and 1 grade IV neutropenia associated with thalidomide.Several similar studies show promise, but the combination of rituximab and thalidomide still requires investigation and is not currently recommended by any guidelines.
S.J. Richardsonet al, Activity of Thalidomide and Lenalidomide in Mantle Cell Lymphoma Acta Haematol 2010;123:21-29
Kaufmann H, Raderer M, Wöhrer S, Püspök A, Bankier A, Zielinski C, Chott A,Drach J. Antitumor activity of rituximab plus thalidomide in patients with relapsed/refractory mantle cell lymphoma.Blood. 2004 Oct 15;104(8):2269-71.
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