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Drug information (i. Anti-infectives, ii. cytostatics, iii. others)
Bendamustine in lymphomas: a review of its use
  1. I. Cañamares,
  2. C. Gomez-Baraza,
  3. M.J. Agustin,
  4. N. de la Llama,
  5. J.M. Real,
  6. M.R. Abad-Sazatornil
  1. 1Servet, Hospital Pharmacy, Zaragoza, Spain

Abstract

Background Bendamustine is an alkylating agent recently approved in several European countries for non-Hodgkin's lymphoma (NHL) refractory to rituximab (R).

Purpose To describe bendamustine use in lymphomas and review safety in our clinical practice.

Materials and methods Retrospective study carried out during 2010. The following data were collected: sex, age, previous treatment, bendamustine dosage, treatment duration, % adverse reactions (ARs), % colony-stimulating factor required and reduction of the initial dose of bendamustine.

Results 7 patients received bendamustine: 71.4% male, age 53.9 at the beginning of bendamustine treatment. 42.8% Hodgkin's lymphoma (HL) and 57.2% NHL, 50.0% were mucosa-associated lymphoma tissue (MALT) and 50.0% follicular NHL. An average of 3 treatment lines were used before bendamustine was used. In NHL patients (n=4), first-line treatment was CHOP±R; several schemes were used in the second line (BEACOPP-14, DHAP). Bendamustine was used as third line: 50% combined with rituximab and 50.0% in monotherapy. There were no standard dose criteria for bendamustine: 90 mg/m2 (2 patients), 100 mg/m2 and 120 mg/m2 one each. In HL patients (n=3), 2 patients received ABVD followed by bone marrow transplant and 1 patient BEACOPP-14 at first. In second and third-line treatment different schemes were administered (BEACOPP-14, GEMOX, DHAP and CNOP). As the fourth line bendamustine was requested as off-label at 110-120 mg/m2. In this study, bendamustine treatment was continued for 22.85 weeks (95% CI 19.11 to 26.60). The most common AR was haematological toxicity (85.7%); grade 3-4 neutropenia appeared in 9.5% and anaemia in 4.8% of patients. Use of colony-stimulating factor and epoetin alfa were essential in 71.4% patients; it was not necessary to reduce the dose of bendamustine. Other ARs were fatigue 14.3%, fever, nausea or vomiting 9.5%.

Conclusions Experience with bendamustine in Hodgkin's and Non-Hodgkin's lymphoma in our institution is limited. Haematological toxicity is common and can be managed with colony-stimulating factor.

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