Lenalidomide, idelalisib, and rituximab are unacceptably toxic in patients with relapsed/refractory indolent lymphoma by Chan Yoon Cheah, Loretta J. Nastoupil, Sattva S. Neelapu, Sheryl G. Forbes, Yasuhiro Oki, and Nathan H. Fowler Blood Volume 125(21):3357-3359 May 21, 2015 ©2015 by American Society of Hematology

Biochemical and immunologic changes in patients treated with rituximab, lenalidomide, and idelalisib over time. Biochemical and immunologic changes in patients treated with rituximab, lenalidomide, and idelalisib over time. (A) Kinetics of elevation of ALT (upper limit of normal, 56 IU/L) for the first 6 patients treated with rituximab, idelalisib, and lenalidomide (patient 7 did not develop abnormalities). (B) Change in peripheral blood lymphocyte numbers and (C) T-cell activation markers in patient 6, who died of hepatic failure, at study entry (baseline) and during acute liver failure (day 116). Elevation of CD69 and the costimulatory molecules ICOS, 4-1BB (CD137), and OX40 (CD134) on both CD4+ and CD8+ T cells suggested marked T-cell activation. Percentages shown are the percent of CD4+ or CD8+ T cells expressing the appropriate marker. NK, natural killer; Pt, patient; Tregs, regulatory T cells. Chan Yoon Cheah et al. Blood 2015;125:3357-3359 ©2015 by American Society of Hematology