A phase 2 study published in Nature Communications (NCT04404088) showed that the frontline, chemotherapy-free combination of acalabrutinib (Calquence), lenalidomide (Revlimid), and rituximab (Rituxan) was both safe and effective for patients with advanced-stage, high-tumor-burden follicular lymphoma.
Among 24 patients with a median follow-up of 43 months, the best complete response rate reached 92% after just six treatment cycles, indicating rapid and deep tumor control. The median progression-free survival and overall survival were not reached, suggesting durable responses. At three years, 62% of patients remained progression-free, and 87% were alive.
Treatment was generally well tolerated. The most frequent side effects of any grade included neutropenia (91%), anemia (83%), fatigue (79%), thrombocytopenia (67%), and headache (58%). Severe (grade 3–4) neutropenia occurred in 58% of patients but was manageable with standard supportive care.
The authors concluded that this triplet regimen offers an effective, non-chemotherapy option for patients requiring initial treatment of follicular lymphoma, achieving high and early complete response rates. Ongoing research is exploring shorter treatment durations and potential use in marginal zone lymphoma.