Publication Date:
2014-12-06
Description:
Background: The use of lenalidomide is expanding to include patients with refractory or relapsed diffuse large B cell lymphoma (DLBCL). Lenalidomide is less toxic than thalidomide, but it leads to hypothyroidism in approximately 5-10% of patients that are treated with this medication. The mechanism of lenalidomide-induced hypothyroidism is poorly understood, and it is important to better understand this phenomenon as its new applications in DLBCL portend much broader use. Methods: In this study we compared rates of therapy-induced hypothyroidism in 329 consecutive patients diagnosed with DLBCL between 2000 and 2013 who were treated at Vanderbilt University Medical Center with conventional chemotherapy (DLBCL-c) or conventional chemotherapy plus lenalidomide (DLBCL-len). No patients were excluded for any reason, and our study protocol was approved by our institutional review board. We also measured serum levels of tumor necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), interleukin-6 (IL-6), interleukin-12 (IL-12), and interleukin-15 (IL-15) in 27 patients before and after treatment with lenalidomide. The student’s t test and Mann-Whitney U rank sum test were used to compare continuous variables. For discrete variable comparisons the X2-test or Fisher’s exact test were used. All statistical analyses were performed with SPSS.21 software. Results: Amongst our 298 patients with DLBCL who were not treated with lenalidomide (DLBCL-c group), the median age was 60 years (range 17-97 years) and 181 (61%) were male. Amongst our 31 patients treated with lenalidomide (DLBCL-len) the median age was 56 years (range 29-85 years) and 15 (48%) were male. A larger proportion of patients treated with lenalidomide had high-risk disease by international prognostic index (IPI) ≥3 (80.5% in the DLBCL-len group compared to 33.5% in the DLBCL-c group). In the DLBCL-c group only four patients (1.3%) developed hypothyroidism compared to eight patients (25.8%) in the DLBCL-len group (p
Print ISSN:
0006-4971
Electronic ISSN:
1528-0020
Topics:
Biology
,
Medicine
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