Lenalidomide for aggressive B-cell lymphoma involving the central nervous system?

Lymphomas arising or relapsing in the central nervous system (CNS) have a dismal prognosis [1]. Very few active drugs passing through the blood brain barrier are available. Lenalidomide is a novel and extremely active compound in relapsed diffuse-large-B-cell-lymphoma (DLBCL) and mantle cell lymphoma (MCL) [2,3]. The pleiotropic action of Lenalidomide needs to be further exploited in different clinical settings and in combination with other drugs [4,5]. Thus far, patients with aggressive lymphomas and CNS involvement have been excluded from clinical trials and there are no data about Lenalidomide penetration in the CNS. Very recently, it was reported that Lenalidomide induced remission in a case of DLBCL relapsed within the CNS [6]. Here, we refer on a case of blastoid MCL [7] relapsed within the orbit and the CNS. The patient failed chemotherapy but achieved remission on Lenalidomide therapy. Furthermore, the presence of the drug was ascertained in the blood and in the cerebrospinal fluid (CSF) using an LC-MS/MS system consisting of a quadrupole mass spectrometer.