Loading
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.
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.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
650 enrolled.
median not reached
SourceNumbers not yet public.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survivalprimary | Lenalidomide maintenance | - | median not reached | 0.708 (0.537 to 0.933) | 0.01 | link |
| Placebo | - | 58.9 months | ||||
| Overall survival | Lenalidomide maintenance | - | - | 1.218 (0.861 to 1.721) | 0.26 | - |
| Placebo | - | - |
Shares Gilles Salles, Maintenance and consolidation in lymphoma: where it works and where it does not, LYSA (The Lymphoma Study Association), Maintenance therapy and the tag lymphoma-evidence.
Shares Gilles Salles, Maintenance and consolidation in lymphoma: where it works and where it does not, LYSA (The Lymphoma Study Association), Maintenance therapy and the tag lymphoma-evidence.
Shares Gilles Salles, Maintenance and consolidation in lymphoma: where it works and where it does not, LYSA (The Lymphoma Study Association), Maintenance therapy and the tag lymphoma-evidence.
Shares Older and multimorbid patients are excluded and undertreated, Lenalidomide, Rituximab, 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 and the tag lymphoma-evidence.
Shares International Prognostic Index (IPI), R-CHOP (lymphoma chemoimmunotherapy), Rituximab, 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 and the tag lymphoma-evidence.
Shares International Prognostic Index (IPI), R-CHOP (lymphoma chemoimmunotherapy), Rituximab, 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 and the tag lymphoma-evidence.
Shares Catherine Thieblemont, LYSA (The Lymphoma Study Association), Maintenance therapy, Rituximab and the tag lymphoma-evidence.
Shares Maintenance and consolidation in lymphoma: where it works and where it does not, Maintenance therapy, Rituximab, 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 and the tag lymphoma-evidence.