TO THE EDITOR:

Chemoimmunotherapy represents the standard frontline treatment for patients with low-grade advanced-stage follicular lymphoma (FL) and high tumor burden.1,2 

More recently, the combination of lenalidomide, an oral immunomodulatory agent, and rituximab (R2) has been investigated in 3 phase 2 studies (NCT01307605, NCT00695786, NCT01145495) and a randomized phase 3 trial (NCT01476787, NCT01650701) named RELEVANCE.4-7  In the latter, 1030 patients with advanced-stage FL were randomized to receive frontline R2 or chemoimmunotherapy. Although the primary end point was progression-free survival (PFS), in light of the limited median follow-up (3 years), results for the coprimary end point (complete remission [CR] at 30 months) were reported; R2 had similar efficacy to chemoimmunotherapy. As such, R2 has been used by several clinicians as an alternative frontline treatment option to chemoimmunotherapy in select patients. Long-term follow-up data...

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