Abstract
Despite the success of standard treatments in chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL), patients are often unable to tolerate aggressive regimens, and they require effective alternatives. Bendamustine is a bifunctional alkylator with unique properties that significantly distinguish it from other agents in its class. In untreated CLL, bendamustine has demonstrated rates of response and progression-free survival (PFS) that are superior to those with chlorambucil, with an acceptable toxicity profile. In the relapsed setting, combination treatment with bendamustine-rituximab (BR) has demonstrated promising activity in high-risk patients such as those refractory to fludarabine or alkylating agents. In untreated patients with indolent NHL and mantle cell lymphoma, BR has demonstrated a PFS significantly longer than that achieved with R-CHOP (rituximab-cyclophosphamide-doxorubicin-vincristine-prednisone), with significantly reduced toxicity. In the relapsed setting, br has demonstrated rates of response and PFS superior to those with fludarabine-rituximab, with comparable toxicity. In the United States and Europe, bendamustine has been approved for the treatment of CLL and indolent NHL; its approval in Canada is pending and eagerly awaited. Once available, bendamustine will benefit many Canadian patients with NHL and CLL.
Highlights
Since the year 2000, considerable progress has been made in the treatment of chronic lymphocytic leukemia, indolent non-Hodgkin lymphoma, and mantle cell lymphoma
Bendamustine has been approved in a number of countries for the treatment of hematologic malignancies, it has not yet been approved in Canada. (It is currently under review at Health Canada.) Here, we review the role of bendamustine in cll, indolent nhl, and mcl; the information presented does not reflect a true evidence-based guideline or systematic literature review
Bendamustine is a bifunctional alkylator with unique properties that distinguish it from other agents in its class, showing only partial cross-resistance to other alkylators such as cyclophosphamide [3,4,5]
Summary
Since the year 2000, considerable progress has been made in the treatment of chronic lymphocytic leukemia (cll), indolent non-Hodgkin lymphoma (nhl), and mantle cell lymphoma (mcl). Bendamustine hydrochloride is a bifunctional alkylating agent with clinical activity across a number of cancers, including breast cancer, small-cell lung cancer, multiple myeloma, cll, indolent nhl, and mcl [2,3]. Bendamustine has three structural elements: a 2-chloroethylamine alkylating group, a benzimidazole ring, and a butyric acid side chain [3,5]. In the United States and Europe, bendamustine is approved for the first-line treatment of cll and relapsed indolent nhl. The use of bendamustine is recommended in both the European Society for Medical Oncology and the National Comprehensive Cancer Network consensus guidelines for the treatment of cll and indolent nhl, and in the National Comprehensive Cancer Network guidelines for the treatment of mcl 4
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