Lenalidomide plus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R2-CHOP) was safe and effective as first-line treatment for patients with follicular lymphoma (FL), according to a study published in The Lancet Haematology.

Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is a standard front-line treatment for patients with follicular lymphoma, and previous studies have shown that lenalidomide plus rituximab is a highly effective option as well. The effectiveness of using these 2 regimens in combination requires further study.

For this phase 2 study, researchers enrolled 80 patients with previously untreated high-burden FL. Induction therapy consisted of 6 cycles of R2-CHOP every 3 weeks followed by 2 rituximab infusions.

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Results showed that 68 (85%) of study enrollees completed all 6 cycles of R2-CHOP. Overall, 75 of the 80 patients achieved an objective response; by the end of the induction phase, 59 (74%) and 16 (20%) had complete (CR) and partial responses (PR), respectively. At 30 months after enrollment, 55 (69%) patients had a CR.

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The most frequently observed grade 4 adverse event (AE) was neutropenia, which occurred in 52 (65%) of patients. Nonhematologic AEs included grade 1 to 2 sensory neuropathy and transient rash.

R2-CHOP treatment had adequate safety and good clinical activity among patients with high-burden FL. The authors concluded that “a future comparative study showing evidence of a survival advantage would be necessary for this combination to be proposed as a treatment for follicular lymphoma.”


Tilly H, Morschhauser F, Casasnovas O, et al. Lenalidomide in combination with R-CHOP (R2-CHOP) as first-line treatment of patients with high tumour burden follicular lymphoma: a single-arm, open-label, phase 2 study [published online September 1, 2018]. Lancet Haematol. doi: 10.1016/S2352-3026(18)30131-5