# Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell lymphoma treated with first-line R-CHOP

Source: https://onco.cc/key-papers/paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017/  
OnCo record `paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Two years of a tablet after chemotherapy delayed relapse in older people with aggressive lymphoma but did not help them live longer.

## Summary

A randomised phase 3 trial in 650 patients aged 60 to 80 with previously untreated diffuse large B-cell lymphoma or another aggressive B-cell lymphoma who had reached a complete or partial response after six or eight cycles of R-CHOP. They received lenalidomide 25 mg daily for 21 days of each 28-day cycle for 24 months, or placebo.

At the primary analysis in December 2015, with a median follow-up of 39 months from randomisation, median progression-free survival was not reached with lenalidomide against 58.9 months with placebo (hazard ratio 0.708, 95 per cent confidence interval 0.537 to 0.933, p = 0.01). The result was consistent across subgroups by sex, age-adjusted International Prognostic Index, age, response quality after R-CHOP and positron emission tomography status at randomisation. With longer follow-up to October 2016 (median 52 months), overall survival was similar between the arms (hazard ratio 1.218, 0.861 to 1.721, p = 0.26). Grade 3 or 4 neutropenia occurred in 56 against 22 per cent and cutaneous reactions in 5 against 1 per cent.

## Fields

- Kind: Key paper
- Last checked: 2026-10-01
- Also known as: REMARC; Thieblemont 2017
- Tags: lymphoma-evidence
- Journal: Journal of Clinical Oncology
- Year: 2017
- DOI: 10.1200/JCO.2017.72.6984
- Authors: Thieblemont C, Tilly H, Gomes da Silva M, et al.
- Findings: Median progression-free survival was not reached with lenalidomide maintenance against 58.9 months with placebo (hazard ratio 0.708, 95 per cent confidence interval 0.537 to 0.933, p = 0.01).; The effect was consistent across the analysed subgroups, including positron emission tomography status at randomisation.; Overall survival was similar between arms at a median follow-up of 52 months (hazard ratio 1.218, 0.861 to 1.721, p = 0.26).; Grade 3 or 4 neutropenia occurred in 56 per cent on lenalidomide against 22 per cent on placebo.
- What it means: A clean example of a progression-free survival benefit that did not become a survival benefit. Lenalidomide maintenance did not become standard practice after this trial, and the figures are the reason.
- Caveats: Progression-free survival and overall survival were reported at different data cut-offs, 39 and 52 months.; Restricted to patients aged 60 to 80 who had already responded to R-CHOP.; Two years of daily tablets with grade 3 or 4 neutropenia in over half the treated group is a substantial burden for a benefit confined to one endpoint.

## Sources

- Journal of Clinical Oncology 2017: https://doi.org/10.1200/JCO.2017.72.6984
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28426350/
- Europe PMC: https://europepmc.org/article/MED/28426350

## Connected records

- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)
- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/)
- drugs: [Lenalidomide](https://onco.cc/drugs/lenalidomide/), [Rituximab](https://onco.cc/drugs/rituximab/)
- companies: [LYSA (The Lymphoma Study Association)](https://onco.cc/companies/lysa/)
- terms: [Maintenance and consolidation in lymphoma: where it works and where it does not](https://onco.cc/terms/lymphoma-tx-maintenance/), [Maintenance therapy](https://onco.cc/terms/maintenance-therapy/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/)
- trials: [REMARC](https://onco.cc/trials/remarc/)
- people: [Catherine Thieblemont](https://onco.cc/people/catherine-thieblemont/), [Gilles Salles](https://onco.cc/people/gilles-salles/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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