Lenalidomide with rituximab for previously treated follicular lymphoma

2.1 Lenalidomide (Revlimid, Celgene) with rituximab is indicated 'for the treatment of adult patients with previously treated follicular lymphoma (Grade 1 – 3A)'.

2.2 The recommended starting dosage of lenalidomide is 20 mg, orally once daily on days 1 to 21 of repeated 28‑day cycles for up to 12 cycles of treatment. The recommended starting dosage of rituximab is 375 mg/m² intravenously every week in cycle 1 (days 1, 8, 15, and 22) and day 1 of every 28‑day cycle for cycles 2 to 5.

2.3 Lenalidomide is available as a 21‑capsule pack. The cost per pack is £4,168.50 (20 mg; excluding VAT; BNF online, accessed January 2020). The company has a commercial arrangement. This makes lenalidomide available to the NHS with a discount. The size of the discount is commercial in confidence. It is the company's responsibility to let relevant NHS organisations know details of the discount. The list price of rituximab (MabThera) is £349.25 per two 100‑mg vials and £873.15 per one 500‑mg vial (excluding VAT; BNF online, accessed January 2020). Napp and Sandoz have agreed a nationally available price reduction for biosimilar rituximab with the Commercial Medicines Unit. The prices agreed through the framework are commercial in confidence.