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Lenalidomide in chronic lymphocytic leukemia

ABSTRACT Introduction: Chronic lymphocytic leukemia (CLL) is a complex disease. Insights into its pathogenesis and the interplay between B cell receptor (BCR) signaling and tumor microenvironment (TME) have provided newer therapeutic targets for the treatment of CLL. Lenalidomide is a 2nd generation, immunomodulatory analogue with demonstrated clinical activity in CLL, both as an initial therapy and in patients with progressive disease. Areas covered: Lenalidomide pharmacological properties, mechanisms of action, clinical activity, adverse effect profile and its potential for further use are discussed here. This review offers an insight into the unique mechanisms of action of lenalidomide and provides an overview of the clinical experience with lenalidomide in patients with CLL. Expert opinion: Lenalidomide demonstrates efficacy among patients with CLL, both as monotherapy and as combination regimens. Its activity has been explored in patients with relapsed and previously untreated disease. Lenalidomide is best tolerated when given daily at a lower starting dose with gradual, dose escalation. Patients with CLL undergoing treatment with lenalidomide should be monitored for tumor lysis syndrome and myelosuppression. Tumor flare reactions can be observed in patients with CLL during the initial phases of treatment. Newer ongoing trials are studying combination of lenalidomide with newer monoclonal antibodies and kinase inhibitors.