# REMARC

Source: https://onco.cc/trials/remarc/  
OnCo record `remarc` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Two years of a tablet taken after chemotherapy delayed relapse in older people with aggressive lymphoma but did not help them live longer, and caused low white cell counts in over half.

## Summary

REMARC randomised 650 people aged 60 to 80 who had reached a complete or partial response after first-line R-CHOP to lenalidomide 25 mg daily for 21 of every 28 days for 24 months, or placebo.

At the primary analysis, 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, a hazard ratio of 0.708 (95 per cent confidence interval 0.537 to 0.933, p = 0.01). The effect was consistent by sex, by age-adjusted International Prognostic Index, by response quality and by positron emission tomography status at randomisation. With longer follow-up of 52 months, overall survival was no different (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, and cutaneous reactions in 5 against 1 per cent.

REMARC is the clearest example in aggressive lymphoma of a maintenance strategy that delays progression without extending life, and of why that distinction is worth explaining to a patient weighing two years of tablets and blood counts. Lenalidomide maintenance did not become a standard of care on this result.

## Fields

- Kind: Trial
- Status: mixed
- Last checked: 2026-10-01
- Also known as: Lenalidomide maintenance in elderly diffuse large B-cell lymphoma; REMARC trial
- Tags: lymphoma-evidence
- Registry id: NCT01122472
- Phase: 3
- Setting: Aged 60 to 80, in complete or partial response after six or eight cycles of R-CHOP: two years of lenalidomide maintenance against placebo
- Sponsor: The Lymphoma Academic Research Organisation
- Enrolled: 650
- Result: Progression-free survival hazard ratio 0.708 (p = 0.01); overall survival unchanged (hazard ratio 1.218, p = 0.26), with grade 3 or 4 neutropenia in 56 per cent.
- Outcomes: Progression-free survival: Lenalidomide maintenance vs Placebo 58.9 months, HR 0.708; Overall survival: Lenalidomide maintenance vs Placebo, HR 1.218
- Replication: Not replicated; the contemporaneous first-line lenalidomide combinations took a different route.

## Sources

- ClinicalTrials.gov NCT01122472: https://clinicaltrials.gov/study/NCT01122472
- Journal of Clinical Oncology 2017: https://doi.org/10.1200/JCO.2017.72.6984

## Connected records

- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- fronts: [Chemotherapy](https://onco.cc/fronts/chemotherapy/), [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: [International Prognostic Index (IPI)](https://onco.cc/terms/ipi-score/), [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/)
- 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/)
- key papers: [Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell lymphoma treated with first-line R-CHOP](https://onco.cc/key-papers/paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017/)
- 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/)

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