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Early Use of Lenalidomide With Pneumococcal Vaccine for High-Risk CLL

By: Joseph Fanelli
Posted: Monday, October 19, 2020

For patients with high-risk chronic lymphocytic leukemia (CLL), the oral immunomodulatory agent lenalidomide seems to be effective with manageable toxicities as an early intervention treatment strategy. However, it did not seem to enhance the humoral response to the 13-valent protein-conjugated pneumococcal vaccine (PCV13), according to findings presented in Clinical Cancer Research. Results from this phase II trial, concluded Farrukh T. Awan, MD, of the Harold C. Simmons Comprehensive Cancer Center at The University of Texas Southwestern Medical Center, Dallas, and colleagues, suggest the feasibility of this strategy for this patient population.

"Our study suggests that low-dose lenalidomide can be administered to asymptomatic, genetically high-risk early-stage CLL patients with modest toxicity and high rates of durable clinical response," the authors said.

In this study, 49 patients with genetically high-risk CLL or small lymphocytic lymphoma were enrolled. They received either lenalidomide concurrently with or sequentially to two doses of PCV13. All patients did not meet the International Workshop on CLL treatment criteria.

For those patients treated with lenalidomide concurrently with PCV13, four serotypes (3, 4, 5, and 6B) achieved the additional serprotection definition of a fourfold increase. Six serotypes (3, 4, 5, 6B, 19A, and 19F) achieved the same in patients treated with lenalidomide sequentially with PCV13. All enrolled patients achieved the defined concentration of 0.35 mg/mL for at least one serotype tested.

The authors observed no significant difference between the two groups with the addition of lenalidomide. At a median time of treatment of 3.6 years, the median progression-free survival was 5.8 years. Progression-free survival rates at 1, 2, and 3 years were 85%, 79%, and 72%, respectively.

Disclosure: For full disclosure of the study authors, visit aacrjournals.com.



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