Bendamustine for the treatment of indolent non-Hodgkin’s lymphoma and chronic lymphocytic leukemia

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BlankAmerican Journal of Health-System Pharmacy, Vol. 67, Issue 9, 713-723

Bendamustine for the treatment of indolent non-Hodgkin’s lymphoma and chronic

lymphocytic leukemia

Anjana Elefante and Myron S. Czuczman

ANJANA ELEFANTE, PHARM.D., B.SC.PHM., is Clinical Pharmacist, Department of

Pharmacy; and MYRON S. CZUCZMAN, M.D., is Chief, Lymphoma/Myeloma Service,

Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY

Address correspondence to Dr. Elefante at the Department of Pharmacy, Roswell

Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263

(angie.elefante@... ).

Purpose. The pharmacology, efficacy, safety, and dosage and administration of

bendamustine and its use in indolent non-Hodgkin’s lymphoma (NHL) and chronic

lymphocytic leukemia (CLL) are reviewed.

Summary. Bendamustine is an alkylating agent that has a unique, multifaceted

mechanism of action. Compared with other alkylators, bendamustine produces

more-extensive and long-lasting DNA damage. Bendamustine also inhibits

cell-cycle checkpoints, leading to mitotic catastrophe and apoptosis.

Bendamustine is approved for the treatment of CLL and for indolent B-cell NHL

that has progressed during or within 6 months of treatment with rituximab or a

rituximab-based regimen. In Phase II and III trials in patients with indolent

NHL and CLL, bendamustine has demonstrated response rates of 67–84% as a single

agent and median durations of response of 7–21 months. Additional clinical

trials are examining bendamustine as a single agent and in combination therapy

for the treatment of hematologic malignancies and solid tumors. Adverse events

associated with bendamustine are typically mild to moderate and can usually be

managed with supportive care. Myelosuppression is the most common grade 3 or 4

adverse event. Tumor lysis syndrome has been reported to occur in some patients,

and preventive measures should be taken in at-risk patients. The dosage and

administration differ for the treatment of NHL and CLL.

Conclusion. Bendamustine is a well- tolerated and effective chemotherapeutic

agent indicated for the treatment of rituximab-refractory, indolent NHL and CLL.

It has demonstrated efficacy in patients whose disease is refractory to other

therapies, including other alkylating agents.

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