Lei Wen, Zhou Ke-Shu, Li Yu-Fu
Department of Hematology, Henan Cancer Hospital, Henan Institute of Hematology, Zhengzhou 450008, Henan Province, China.
Department of Hematology, Henan Cancer Hospital, Henan Institute of Hematology, Zhengzhou 450008, Henan Province, China. E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2014 Apr;22(2):565-8. doi: 10.7534/j.issn.1009-2137.2014.02.056.
In recent years, the incidence of chronic lymphocytic leukemia (CLL) is increasing. Microenvironment and immune system play a key role in the pathogenesis of CLL. The immune system is aggravated by the use of chemotherapeutic agents, such as fludarabine and cyclophosphamide with rituximab(FCR) which are the current standards in frontline therapy. This leads to an increase of infection incidence in patients, resulting in a poor prognosis. The present situation was changed by lenalidomide. Recent studies indicated that lenalidomide monotherapy in treatment of refractory or relapsed CLL patients, the overall response rate(ORR) reached about 32%-47%, CR roughly was 7%-13%; when lenalidomide and rituximab were combined for treatment of refractory or relapsed CLL patients, the ORR reached about 53%-66%, CR about 12%-13%. Moreover, when lenalidomide and ofatumumab were combined, the efficacy is improved significantly and the adverse reactions are greatly reduced. The adverse reactions are neutrophilic granulocytopenia, thrombocytopenia, anemia, tumor lysis syndrome(TLS), tumor flare reaction(TFR) and venous thromboembolism(VTE). This review focuses on the related studies and the latest progress about lenalidomide in CLL.
近年来，慢性淋巴细胞白血病（CLL）的发病率正在上升。微环境和免疫系统在CLL的发病机制中起关键作用。化疗药物的使用会加重免疫系统负担，如氟达拉滨、环磷酰胺联合利妥昔单抗（FCR），这是目前一线治疗的标准方案。这导致患者感染发生率增加，预后较差。来那度胺改变了这一现状。近期研究表明，来那度胺单药治疗难治性或复发性CLL患者时，总缓解率（ORR）约为32%-47%，完全缓解（CR）率约为7%-13%；当来那度胺与利妥昔单抗联合治疗难治性或复发性CLL患者时，ORR约为53%-66%，CR约为12%-13%。此外，来那度胺与奥法木单抗联合使用时，疗效显著提高，不良反应大大减少。不良反应包括中性粒细胞减少、血小板减少、贫血、肿瘤溶解综合征（TLS）、肿瘤细胞因子释放综合征（TFR）和静脉血栓栓塞（VTE）。本文综述了来那度胺在CLL方面的相关研究及最新进展。
