How is lenalidomide plus Rituxan (rituximab) administered?

From the Guidelines

Lenalidomide plus Rituxan (rituximab) is administered with lenalidomide at an initial dose of 2.5 mg/d, with dose escalation up to 10 mg/d, given 21 days of a 28-day cycle, and rituximab at a dose escalated to 375 mg/m2 cycle 1,375 mg/m2 weekly for 4 weeks in cycle 2, then on day 1 for cycles 3–7 1.

Key Administration Details

• The dose of lenalidomide can be escalated up to 10 mg/d, but the initial dose is lower to minimize toxicity.
• Rituximab is administered at a standard dose of 375 mg/m2, with a specific schedule to maximize its efficacy.
• The combination is typically given for 7 cycles, but the duration of treatment may vary depending on the patient's response and tolerance.

Important Considerations

• Tumor flare reactions are common, occurring in up to 71% of patients, but are usually grade 1 or 2 1.
• Neutropenia is a significant toxicity, with grade 3 or 4 events reported in up to 49% of patients 1.
• The combination of lenalidomide and rituximab has shown promising efficacy in patients with CLL, including those with del(11q) and del(17p) deletions 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Administer only as an intravenous infusion (2.1). The dose for adult and pediatric B-cell NHL is 375 mg/m2 (2. 2). RITUXAN is given by infusion through your or your child's central catheter or through a needle placed in a vein (intravenous infusion), in your or your child's arm.

The administration of lenalidomide plus Rituxan (rituximab) is not directly addressed in the provided drug labels. However, based on the available information, Rituxan (rituximab) is administered as an intravenous infusion. The dose of rituximab varies depending on the condition being treated, but common doses include 375 mg/m2 for adult and pediatric B-cell NHL. Lenalidomide administration is not mentioned in the provided drug labels. 2 2

From the Research

Administration of Lenalidomide plus Rituximab

The administration of lenalidomide plus rituximab is as follows:

• Lenalidomide is given orally, with doses ranging from 10 mg to 25 mg per day, depending on the study and patient population 3, 4, 5.
• Rituximab is administered intravenously, with a typical dose of 375 mg/m², given once a week during the first cycle, and then once every 8 weeks 3, 4, 5.
• The treatment cycle typically lasts 28 days, with lenalidomide given on days 1-21, and rituximab given on day 1 of each cycle 3, 5.
• The duration of treatment varies, but can continue until disease progression, stem-cell transplantation, or severe toxicity 3.

Dosing Regimens

Different studies have used varying dosing regimens, including:

• 20 mg lenalidomide per day, given on days 1-21 of each 28-day cycle, with 375 mg/m² rituximab given on day 1 of each cycle 3.
• 15 mg lenalidomide per day, given on days 1-21 of each 28-day cycle, with 375 mg/m² rituximab given once a week during the first cycle, and then once every 8 weeks 4.
• 10 mg to 20 mg lenalidomide per day, given on days 1-21 of each 28-day cycle, with 375 mg/m² rituximab given on day 1 of each cycle 5.

Treatment Schedules

Treatment schedules have also varied across studies, including:

• Induction phase of 12 cycles, followed by a maintenance phase with rituximab only 4.
• Treatment continued until disease progression, stem-cell transplantation, or severe toxicity 3.
• Treatment given for up to 12 cycles, with responding patients able to continue therapy 5.