lenalidomide + fludarabine + rituximab

This combination therapy regimen, evaluated in the REVLIRIT CLL-5 AGMT phase I/II study, consists of the immunomodulatory drug lenalidomide, the purine analog fludarabine, and the anti-CD20 monoclonal antibody rituximab. Developed by the Arbeitsgemeinschaft Medikamentöse Tumortherapie (AGMT), the regimen is designed for the treatment of previously untreated chronic lymphocytic leukemia (CLL). Lenalidomide acts by binding to the cereblon E3 ubiquitin ligase complex, leading to the degradation of Ikaros and Aiolos transcription factors, which results in direct anti-tumor effects and immune system stimulation. Fludarabine acts as a chemotherapy agent that inhibits DNA synthesis, while rituximab targets CD20-positive B-cells to induce cell death through antibody-dependent cellular cytotoxicity and complement-mediated lysis. The study specifically explored escalating doses of lenalidomide to optimize efficacy while managing toxicities like tumor flare and tumor lysis syndrome.

Other names

Lenalidomide, Fludarabine, and Rituximab in Untreated CLLLFR regimen