Mantle cell lymphoma (MCL) comprises 3–10% of NHL, with survival times ranging from 3 and 5 years. Indolent lymphomas represent approximately 30% of all NHLs with patient survival largely dependent on validated prognostic scores. High response rates are typically achieved in these patients with current first-line chemoimmunotherapy. However, most patients will eventually relapse and become chemorefractory with poor outcome. Alternative chemoimmunotherapy regimens are often used as salvage strategy and stem cell transplant remains an option for selected patients. However, novel approaches are urgently needed for patients no longer responding to conventional chemotherapy. Lenalidomide is an immunomodulatory drug with activity in multiple myeloma, myelodisplastic syndrome and chronic lymphoproliferative disorders. In phase II studies of indolent NHL and MCL lenalidomide has shown activity with encouraging response rates, both as a single agent and in combination with other drugs. Some of these responses may be durable. Optimal dose of lenalidomide has not been defined yet. The role of lenalidomide in the therapeutic armamentarium of patients with indolent NHL or MCL will be discussed in the present paper. 1. Introduction Non-Hodgkin’s lymphomas (NHLs) are a heterogeneous group of lymphoid malignancies. The annual incidence of NHL in the United States is estimated to be 4.5% of all cancers, and they account for 3% of annual cancer-related deaths [1]. From a clinical and therapeutic standpoint, these neoplasias are subdivided into aggressive and indolent forms. Indolent lymphomas represent approximately 30% of all NHLs. Prognosis is correlated with the stage of the disease at the time of diagnosis, as well as to the international prognostic index (IPI) or other IPI-derived scores [2–5]. The current therapeutic approach for indolent NHL is based on the use of chemoimmunotherapy. Intensive treatments such as high-dose chemotherapy with autologous stem cell transplantation (ASCT) are typically reserved for relapsing patients whose disease is still chemosensitive [1]. Mantle cell lymphoma (MCL) comprises approximately 3 to 10% of NHL. It is a heterogeneous clinical entity with four recognized morphologic variants (i.e., classical, blastoid, pleomorphic and small cell, marginal zone-like). The small cell variant tends to be an indolent lymphoma, whereas both the blastoid and pleomorphic variants are associated with a clinical aggressive course. However, the majority (80%) of MCLs show intermediate characteristics. Thus, the median survival of the majority of
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