Treatment Name: Rituximab (Rituxan®) + Lenalidomide (Revlimid®)
Rituximab (Rituxan®) + Lenalidomide (Revlimid®) is a Chemotherapy Regimen for Lymphoma, B-cell
How does rituximab + lenalidomide work?
Rituximab is an antibody that is designed to target and bind to a protein on the surface of cancerous B-cells. When rituximab binds to this protein, it helps your immune system destroy the cancer cell. Lenalidomide is designed to kill cancerous lymphoma cells and to improve the ability of the immune system to target cancerous lymphoma cells.
Goals of therapy:
Rituximab + lenalidomide is given to shrink lymph nodes and decrease symptoms from B-cell Lymphoma such as fevers, night sweats, and weight loss. It is not commonly given with the goal of cure, but to put the lymphoma in remission and keep it in remission.
- Rituximab intravenous (I.V.) infusion on Days 1, 8, 15, and 22 of Cycle 1 only. The time of infusion varies depending upon tolerability
- Usual lenalidomide starting dose: 20 mg oral capsule by mouth daily for 21 consecutive days, then seven days off
Estimated total infusion time for this treatment:
- Up to eight hours for Cycle 1, Day 1; as short as 90 minutes for the first day of next cycles if well tolerated
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time
Lenalidomide is a human teratogen. In order to decrease the risk of embryo-fetal exposure, lenalidomide is available only through a restricted distribution program (Revlimid® REMS).
Rituximab is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick for outpatient care. Lenalidomide is usually taken at home.
Rituximab + lenalidomide is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated until the regimen no longer is working or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the common rituximab + lenalidomide starting doses.
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of rituximab + lenalidomide are shown here:
Approximately 55% of patients in the study required a decrease in the lenalidomide dose or an interruption or discontinuation of treatment due to unacceptable side effects.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment, weekly during the first month, then every two weeks thereafter. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), uric acid, phosphorous, Lactate Dehydrogenase (LDH), plus any others your doctor may order. Hepatitis B screening and Human Immunodeficiency Virus (HIV) screening may also be done before starting treatment.
How often is imaging needed?
Imaging may be checked before treatment then approximately after every two cycles. Imaging may include: computerized tomography (CT) scan, positron emission tomography (PET) scans, and/or bone marrow biopsies.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue rituximab + lenalidomide as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Premedications such as diphenhydramine (Benadryl®), acetaminophen (Tylenol®), and hydrocortisone (Solu-Cortef®) may be given before rituximab to help avoid infusion related reactions
- The first dose of rituximab is often the hardest. It may lead to fever, shaking, and chills even if medications are given beforehand to help prevent these side effects. Side effects generally go away when the rituximab is stopped. It may then be restarted at a slower rate. Most patients are able to receive the entire dose, although it may take longer. In most cases, after the first dose is well tolerated, rituximab can be given over 90 minutes
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for B-cell lymphoma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Rituximab (Rituxan®) + Lenalidomide (Revlimid®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Rituximab (Rituxan®) + Lenalidomide (Revlimid®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Rituximab (Rituxan®) + Lenalidomide (Revlimid®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Rituximab (Rituxan®) + Lenalidomide (Revlimid®)