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Blood, 15 December 2008, Vol. 112, No. 13, pp. 5180-5189.
Prepublished online as a Blood First Edition Paper on September 4, 2008; DOI 10.1182/blood-2008-01-133108.


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NEOPLASIA

Lenalidomide down-regulates the CD20 antigen and antagonizes direct and antibody-dependent cellular cytotoxicity of rituximab on primary chronic lymphocytic leukemia cells

Rosa Lapalombella1, Bo Yu2,3, Georgia Triantafillou1, Qing Liu4, Jonathan P. Butchar5, Gerard Lozanski6, Asha Ramanunni1, Lisa L. Smith1, William Blum1, Leslie Andritsos1, Da-Sheng Wang7, Amy Lehman8, Ching-Shih Chen1,7, Amy J. Johnson1, Guido Marcucci1,4, Robert J. Lee2,3,4, L. James Lee2,3,4, Susheela Tridandapani5, Natarajan Muthusamy1, and John C. Byrd1,4

1 Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, 2 Department of Chemical and Biomolecular Engineering, 3 Center for Affordable Nanoengineering of Polymeric Biomedical Devices, 4 Division of Pharmaceutics, College of Pharmacy, 5 Division of Pulmonary Medicine, Department of Medicine, 6 Department of Pathology, 7 Division of Medicinal Chemistry, College of Pharmacy, and 8 Center for Biostatistics, The Ohio State University, Columbus

Lenalidomide, an immunomodulatory agent that enhances antibody-dependent cellular cytotoxicity (ADCC), is currently being investigated as a therapy for chronic lymphocytic leukemia (CLL). The anti-CD20 antibody rituximab is active in CLL and represents a rational agent to combine with lenalidomide. We therefore examined whether lenalidomide combined with rituximab enhances direct apoptosis and ADCC in CLL cells. In contrast to previous reports using CD20-positive lymphoma cell lines, lenalidomide down-regulated CD20 surface antigen expression in CLL patient cells via enhanced internalization, without influencing transcription. The CD20 surface antigen internalization enhanced delivery of an oligonucleotide incorporated into anti-CD20 immunoliposomes. In addition, CD20 surface antigen down-modulation by lenalidomide in CLL was accompanied by diminished rituximab-mediated apoptosis and ADCC. These observations suggest a need for alternative sequencing strategies to avoid antagonism between lenalidomide and rituximab therapy in CLL. In addition, they suggest that lenalidomide therapy might be useful to enhance targeted delivery of RNAi-based therapies using CD20 immunoliposomes in B-cell malignancies.


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The yin and yang of lenalidomide
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A. G. Ramsay and J. G. Gribben
Immune dysfunction in chronic lymphocytic leukemia T cells and lenalidomide as an immunomodulatory drug
Haematologica, September 1, 2009; 94(9): 1198 - 1202.
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