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

Abstract

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.

Immunomodulatory treatment for mucosa‐associated lymphoid tissue lymphoma (MALT lymphoma)

“…While it is generally low in MALT lymphoma (<5%), it constitutes a crucial event for prognosis. Preliminary data from our own center, however, suggest no increased risk for patients treated with immunomodulatory agents 35,56 …”

“…Again, no new toxicity concerns were raised following a treatment schedule of a maximum of eight times 4‐week cycles (R 375 mg/m 2 , lenalidomide 20 mg daily day 1‐21). For both the MD Anderson Cancer Center data (median follow‐up 75 months, n = 30 for marginal zone lymphomas) and the Austrian data (median follow‐up 68 months, n = 50 patients with MALT lymphoma), long‐term data have been published and reported durable responses 35,38 …”

Rare lymphomas in routine practice – Treatment and outcome in marginal zone lymphoma in the prospective German Tumour Registry Lymphatic Neoplasms

“…Since this study focused on MZL treatment between 2009 and 2016, data from more recent studies exploring the impact of newer drugs including lenalidomide and ibrutinib 9 , 37 , 38 , 39 , 40 , 41 or small molecules targeting pathways in MZL 15 were still limited. In the TLN, more recently approved drugs had been documented for only a single patient (ibrutinib).…”

How do we sequence therapy for marginal zone lymphomas?

“…They found no differences in PFS according to disease stage or previous systemic therapy, although there were limitations related to the number of patients included in their series. 57 In the experience reported by the MD Anderson Cancer Center in 30 previously untreated advanced-stage MZL patients, lenalidomide+rituximab (same schedule as in Kiesewetter et al, with possible treatment extension of lenalidomide only for 6 more cycles if patients were responding) produced an ORR of 93%, with a CR rate of 70% and a median PFS of 60 months at a median follow-up of 75 months. 58,59 Although generated from small cohorts of patients and from subgroup analyses of larger trials involving patients with multiple indolent histologies, these data suggest that lenalidomide and rituximab may represent an attractive chemotherapy-free treatment to be offered to patients with MZL during either induction or salvage treatment.…”