Lenalidomide can modulate levels of CLL B-cell and NK receptors and NK cell–mediated ADCC. Panel A shows the down-regulation of CD20 via internalization while increasing CD38 and CD23 on CLL B cells. Panel B shows that preincubation of CLL B cells with lenalidomide results in reduced NK-mediated ADCC in the presence of rituximab. Panel C shows that preincubation of NK cells with lenalidomide generates “activated” NK cells with increased levels of CD56 and increases in NK-mediated ADCC in the presence of rituximab. Professional illustration by Marie Dauenheimer.