Bendamustine hydrochloride in patients with B-cell malignancies who have comorbidities – is there an optimal dose?

ABSTRACT

Introduction: The majority of patients with non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) present with comorbidities. Many of them are poor candidates for intensive chemo-immunotherapy regimens, such as FCR (fludarabine, cyclophosphamide, rituximab). Still, most clinical trials aim to enroll ‘fit’ patients, who poorly represent the community oncology population.

Areas covered: In the past decade, bendamustine hydrochloride, a cytotoxic agent with structural similarities to both alkylating agents and purine analogs, has received widespread use in therapy of NHL and CLL, and has demonstrated a relatively favorable toxicity profile. However, bendamustine has not been well studied in patients with hematologic malignancies who have comorbidities. Here we review the clinical data on use of bendamustine in older and unfit patients with NHL and CLL, and analyze whether there is an optimal dose of bendamustine in patients who have significant comorbidities, including renal dysfunction.

Expert commentary: Reduced intensity regimens of bendamustine are effective in CLL patients with comorbidities and renal dysfunction. Even with the introduction of targeted therapies, bendamustine will likely continue to be an important therapeutic option in patients with comorbidities because of its tolerability, efficacy and cost.

KEYWORDS:

• Chronic lymphocytic leukemia (CLL)
• non-Hodgkin lymphoma (NHL)
• cumulative illness risk scale (CIRS)
• therapy
• dose reduction
• renal insufficiency

Declaration of interest

AV Danilov is supported by the Lymphoma Research Foundation Clinical Investigator Career Development Award. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

The manuscript was funded by the Lymphoma Research Fund.