Abstract
Bendamustine has become a popular cancer chemotherapeutic agent in the last couple of years. It has replaced some traditional chemotherapy regimens due to its favorable side effect profile. Various cutaneous side effects have been noted following bendamustine usage. These cutaneous eruptions are to known to occur in 15-24% of patients. Benign cutaneous events include lichenoid drug eruptions, flagellate dermatoses and polymorphic papules and plaques in exposed areas. Rarely, severe adverse cutaneous reactions such as Steven Johnson syndrome, drug rash with eosinophilia and systemic symptoms and toxic epidermal necrolysis have been reported. We report a case of a 48 year-old-female who developed an insect bite like rash after initiation of bendamustine for non-Hodgkins lymphoma.
Highlights
Bendamustine is a bifunctional chemotherapeutic agent with both alkylating and antimetabolite properties
In 2008, it was approved by the FDA for the treatment of chronic lymphocytic leukaemia (CLL) and indolent B-cell non Hodgkins lymphoma (NHL)
Bendamustine is known to cause several types of adverse cutaneous reactions ranging from mild forms such as maculopapular rash and polymorphous erythematous papular rash to severe forms such as Steven-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug rash with eosinophilia and systemic symptoms (DRESS) [1,2]
Summary
Bendamustine is a bifunctional chemotherapeutic agent with both alkylating and antimetabolite properties. In 2008, it was approved by the FDA for the treatment of chronic lymphocytic leukaemia (CLL) and indolent B-cell non Hodgkins lymphoma (NHL) Chemotherapeutic agents such as rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone have been previously used for NHL as a part of R-CHOP regimen. A 48-year-old female patient, who was diagnosed with NHL two months ago developed raised itchy lesions of 2 weeks duration She said to have developed these lesions 2 weeks after her first cycle of chemotherapy which comprised of a combination of bendamustine and rituximab. The patient visited us again one month later with persistence of the skin lesions associated with severe pruritus She had completed three cycles of bendamustine and rituximab therapy. The medical oncologist stopped bendamustine after 3 cycles in view of persistent intolerable itching and started her on R-CVP (rituximab, cyclophosphamide, vincristine and prednisolone) regimen, following which her cutaneous lesions improved as observed during her subsequent follow up visits (Figs. 6 and 7)
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