757 Available online at www.medicinescience.org ORIGINAL ARTICLE Medicine Science 2022;11(2):757-61 Lenalidomide treatment in relapsed/refractory B-cell lymphomas: A single center real-life experience Mustafa Merter, Ayse Uysal Fırat University Faculty of Medicine, Department of Hematology, Elazıg, Turkey Received 22 November 2021; Accepted 30 December 2021 Available online 20.03.2022 with doi: 10.5455/medscience.2021.11.380 Copyright@Author(s) - Available online at www.medicinescience.org Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Abstract As an immunomodulatory drug, lenalidomide has been shown to have anti-lymphoma activity and is used in combination with several agents in the treatment of patients with relapsed/refractory disease. In this study, we aimed to evaluate the efciency of lenalidomide in the treatment of B-cell NHL. This retrospective study included pa- tients with relapsed/refractory B-cell NHL who received lenalidomide treatment between March 2018 and January 2021. Patients’ demographic data, dose, and duration of the lenalidomide treatment, combined agents, response rates, side efects, and survival rates were evaluated. Twelve patients who diagnosed with relapsed/refractory NHL were included in the study. Lenalidomide treatment was initiated in combination with rituximab for nine of these patients and with temozolomide for the remaining three of them. At the initiation of the lenalidomide treatment, patients’ median age was 72.5 (24-83) years. Number of females/males was 9/3. Nine of the patients were diagnosed with difuse large b-cell lymphoma (DLBCL), 3 of whom had isolated central nervous system lymphoma (CNS) and 1 had Richter transformation of chronic lymphocytic leukemia. Two patients were diagnosed with mantle cell lymphoma (MCL) and 1 patient was diagnosed with marginal zone lymphoma. The median treat- ment duration was 4 (1-20) months. In the response assessment, 4 patients had complete response while progressed disease was observed in 5 patients. Three patients died before response assessment. In the median 33-month follow-up, progression-free survival and total survival were found as 4 (1-20) and 7 (1-22) months respectively. Due to its low toxicity profle and activity, lenalidomide could be a good option especially for elderly and fragile B-cell lymphoma patients. It is an agent to be considered particularly in lymphomas with CNS involvement with its good CNS penetration. Its synergistic efect may give better results when used in combination with several anti-lymphoma drugs. Keywords: B-cell lymphoma, lenalidomide, immunomodulatory drug, relapsed/refractory disease Introduction Non-Hodgkin lymphomas (NHL) are a heterogonous group of diseases and nearly 85% of them is composed of B-cell lymphomas. They are mainly divided in two groups as aggressive lymphomas and indolent lymphomas [1]. Rituximab, a human anti-CD20 monoclonal antibody, is frequently used in combination with chemotherapy for the treatment of B-cell lymphomas. Although cure is usually possible in aggressive lymphomas with these treatments, the efectiveness of the treatment is limited due to toxicity and recurrence is observed in many of the patients. Thus, there is a need for alternative ways of treatment for such patients [2]. Indolent lymphomas, on the other hand, respond very well to the initial treatment, but eventually relapse [3]. Several treatment strategies could be used at the relapse of both aggressive and indolent lymphomas. While planning the treatment of these patients, response to previous treatment, response durations age and performance at relapse and the patient’s preferences must be considered. Most of the patients are not suitable for high-dose chemotherapy and stem-cell transplantation due to advanced age, low performance, and comorbidities. Recently, new treatment options with low-toxicity profle are available for such patients [4]. Lenalidomide is an immunomodulatory drug (IMID), which binds to the cereblon E3 ubiquitin ligase complex and leads to the ubiquitination of the transcription factors Aiolos and Ikaros. It exerts its anti-lymphoma efects with its antiangiogenic, immunomodulatory and direct cytotoxic properties [5,6]. Vascular endothelial growth factor (VEGF) and its receptors are essential for the formation of blood vessels in carcinogenesis [7]. Lenalidomide shows its antiangiogenic efects via the upregulation of both VEGF and IL-6 [8]. Lenalidomide has several immunomodulatory efects. It improves T-cell activity as well as increasing both the number and activation of NK cells [9]. Immunologic synapse formation of tumor infltrating T-cells is impaired in lymphomas and it was demonstrated that this defect was repaired with lenalidomide [10]. *Corresponding Author: Mustafa Merter, Fırat University Faculty of Medicine, Department of Hematology, Elazıg, Turkey E-mail: dr.mustafamerter@gmail.com Medicine Science International Medical Journal