Review Article

Molecular Action of Lenalidomide in Lymphocytes and Hematologic Malignancies

Figure 2

Lenalidomide augments direct CD8+ T-cell killing of B-CLL cells. B-CLL cells are able to evade immune detection through high levels of PDL-1, low levels of costimulatory molecules like B7-1, and a variety of immune-suppressive cytokines in the microenvironment. Lenalidomide treatment (Len) is able to overcome the immune suppression through upregulation of costimulatory molecules like CD40 and B7-1 (CD80/86) on the CLL cells, upregulation of Fas expression, as well as decreasing PDL-1. Through the alteration of surface molecule expression, as well as the increase in T-cell signaling as shown previously, lenalidomide induces better immune synapse formation allowing for increased killing by the CD8+ T cells.
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