Blood. heterogeneous medical presentations and results. FL continues to be considered incurable despite the improvements in overall survival (OS) observed over the past few decades.3-6 Although a number of highly effective treatment options exist, there is no universally agreed upon standard treatment approach in the first-line or the relapsed/refractory setting (Table 1). Table 1. Clinical tests including follicular lymphoma individuals treated in the first-line and relapsed settings thead valign=”bottom” th rowspan=”1″ colspan=”1″ Research /th th align=”center” rowspan=”1″ colspan=”1″ Dose routine /th th align=”center” rowspan=”1″ colspan=”1″ Response rate /th th align=”center” rowspan=”1″ colspan=”1″ PFS /th /thead First-line follicular lymphoma?Zucca et al915 mg /d with rituximab for 18 wkOR, 82%; CR, 36%Median, 5 y?Fowler et al1020 mg/d days 1-21 (28-d cycle) with rituximab for up to 12 cycles.OR, 98%; CR, 87%Median not reached*3 y, 79%?Martin et al1120-25?mg/d days 1-21 (28-d cycle) with rituximab for up to 12 cyclesOR, 95%; CR, 72%5.y, 72%?Morschhauser et al1320 mg/d days 1-21 (28-d cycle) with rituximab 6 cycles followed by 10 mg/d days 1-21 (28-d cycle) for 12 cycles in individuals with confirmed or unconfirmed CR.OR, 61%; CR, 48%3 y. 77%Relapsed follicular lymphoma?Witzig et al1525 mg/d day time 1-21 (28-d cycle) for up to 52 wkOR, 27%; CR, 9%Median, 4.4 mo?Leonard et al1715-25 mg/d day time 1-21 (28-d cycle), with or without rituximabLenalidomideLenalidomide:OR, 53%; CR, 20%Median time to progression, 1.1 yLenalidomide+rituximab:Lenalidomide+rituximab:OR, 76%; CR, 39%Median time to progression, 2 y?Chong et al1610 mg daily with rituximabOR, 65%; CR, 35%Median, 16.5 mo?Andorsky et al1920 mg/d, day time 1-21 (28-d cycle), with rituximab for 12 cycles, followed by 1:1 randomization of individuals with stable disease to maintenance lenalidomide 10 mg, d 1\21, with rituximab vs rituximab aloneOR, 74%; CR, 46% (for induction phase)Median, 0.2 mo?Leonard et al1820 mg/d day time 1-21 (28-d cycle) with rituximab for 12 cyclesOR, 78%; CR, 34%Median, 39.4 mo Open in a separate window Lenalidomide is an immunomodulatory drug initially approved for use in multiple myeloma and mantle cell lymphoma and recently approved for use with rituximab in the relapse setting for FL. Lenalidomide generates antitumor activity by multiple mechanisms that may vary across lymphoid malignancies. Studies of lenalidomide in FL have demonstrated that this agent activates CD8 T cells, reduces the numbers of regulatory T cells, enhances T-cell immune synapses, and increases the percentage of T-helper 1 subsets over T-helper 2 subsets.7,8 However, this understanding of the effect of lenalidomide on lymphoma tumor and sponsor immune system biology has yet to lead to the development of SB-705498 biomarkers to aid in the selection of individuals who are most likely to benefit from treatment. Such biomarkers would be helpful in selecting FL sufferers probably to reap the benefits of lenalidomide and rituximab in the initial series and relapse configurations also to determine the perfect dosage and timetable for administration in the foreseeable future. SPARC Lenalidomide and rituximab being a first-line therapy for FL The Swiss Group for SB-705498 Clinical Cancers Research as well as the Nordic Lymphoma Group performed a stage 2 trial that likened the experience of rituximab 375 mg/m2 provided weekly for four weeks and repeated on weeks 12 to 15 in responding sufferers (n = 77) compared to that of rituximab provided on a single timetable with lenalidomide 15 mg daily for 18 weeks (n = 77), in untreated FL sufferers looking for therapy previously.9 This trial confirmed the fact that group getting combination therapy had a significantly higher finish response (CR) rate at six months by independent response overview of SB-705498 computed tomographic scans (61% vs 36%), longer progression-free survival (PFS, 5 vs 2.3 years), and even more undesirable events of grade 3 or more (56% vs 22%), although this upsurge in toxicity was controllable in the view from the investigators. As talked about below in the section in the AUGMENT trial, a trial regarding a similar.