Bendamustine

Bendamustine Brand Names

BELRAPZO | BENDEKA | Treanda

What is Bendamustine

Bendamustine is a mechlorethamine derivative containing a purine-like benzimidazole ring; it has properties of both antimetabolites and alkylating agents.

In a multicenter, randomized, phase III study (n = 319), the median progression-free survival time was significantly improved with bendamustine compared with chlorambucil (21.6 months vs. 8.3 months; p < 0.0001) in previously untreated patients with advanced chronic lymphocytic leukemia (CLL) at a median follow-up of 35 months.

In this study, the median overall survival times were not significantly different between treatment arms at a median follow-up time of 54 months.

Treatment with bendamustine led to an overall response rate of 75% and a 9.2 month duration of response in patients with rituximab-refractory, indolent B-cell non-Hodgkin lymphoma (NHL) in a multicenter, single-arm study (n = 100).

Bendamustine (Treanda) received FDA approval for the treatment of CLL in March 2008 and for the treatment of indolent B-cell NHL that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen in October 2008.

A rapid infusion formulation of bendamustine (Bendeka) was approved by the FDA in December 2015.

Indications

  1. acute lymphocytic leukemia (ALL)
  2. chronic lymphocytic leukemia (CLL)
  3. mantle cell lymphoma (MCL)
  4. non-Hodgkin’s lymphoma (NHL)
  5. peripheral T-cell lymphoma (PTCL)
  6. small lymphocytic lymphoma (SLL)

Side Effects

  1. abdominal pain
  2. anaphylactoid reactions
  3. anemia
  4. anorexia
  5. anxiety
  6. arthralgia
  7. asthenia
  8. atrial fibrillation
  9. azoospermia
  10. back pain
  11. bone pain
  12. bullous rash
  13. candidiasis
  14. chest pain (unspecified)
  15. chills
  16. constipation
  17. cough
  18. dehydration
  19. depression
  20. diarrhea
  21. dizziness
  22. drowsiness
  23. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  24. dysgeusia
  25. dyspepsia
  26. dyspnea
  27. elevated hepatic enzymes
  28. erythema
  29. fatigue
  30. fever
  31. gastroesophageal reflux
  32. headache
  33. heart failure
  34. hemolysis
  35. hepatitis
  36. hyperbilirubinemia
  37. hyperglycemia
  38. hyperhidrosis
  39. hypertension
  40. hypertensive crisis
  41. hyperuricemia
  42. hyperuricemia
  43. hypocalcemia
  44. hypokalemia
  45. hyponatremia
  46. hypotension
  47. infection
  48. infertility
  49. infusion-related reactions
  50. injection site reaction
  51. insomnia
  52. leukopenia
  53. lymphopenia
  54. myocardial infarction
  55. nasal congestion
  56. nausea
  57. neutropenia
  58. new primary malignancy
  59. night sweats
  60. palpitations
  61. pancytopenia
  62. peripheral edema
  63. pharyngitis
  64. phlebitis
  65. pneumonitis
  66. pruritus
  67. pulmonary fibrosis
  68. rash
  69. renal failure (unspecified)
  70. sinus tachycardia
  71. sinusitis
  72. skin irritation
  73. skin necrosis
  74. spermatogenesis inhibition
  75. Stevens-Johnson syndrome
  76. stomatitis
  77. thrombocytopenia
  78. toxic epidermal necrolysis
  79. tumor lysis syndrome (TLS)
  80. vomiting
  81. weight loss
  82. wheezing
  83. xerosis
  84. xerostomia

Monitoring Parameters

  • CBC with differential
  • LFTs
  • pregnancy testing
  • serum creatinine/BUN
  • serum electrolytes
  • serum uric acid

Contraindications

  • anemia
  • bone marrow suppression
  • breast-feeding
  • children
  • contraception requirements
  • extravasation
  • hepatic disease
  • hepatitis
  • hepatotoxicity
  • herpes infection
  • infants
  • infection
  • infertility
  • infusion-related reactions
  • male-mediated teratogenicity
  • mycobacterial infection
  • neonates
  • neutropenia
  • pregnancy
  • pregnancy testing
  • renal impairment
  • reproductive risk
  • sepsis
  • serious hypersensitivity reactions or anaphylaxis
  • serious rash
  • thrombocytopenia
  • tuberculosis
  • tumor lysis syndrome (TLS)
  • viral infection

Interactions

  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Amobarbital
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Butabarbital
  • Carbamazepine
  • Cimetidine
  • Ciprofloxacin
  • Clozapine
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Esomeprazole; Naproxen
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Fluvoxamine
  • Hydrocodone; Ibuprofen
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Indomethacin
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Mephobarbital
  • Methohexital
  • Mexiletine
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Norfloxacin
  • Obeticholic Acid
  • Oxaprozin
  • Palifermin
  • Peginterferon Alfa-2b
  • Penicillamine
  • Pentobarbital
  • Phenobarbital
  • Piroxicam
  • Primidone
  • Rifampin
  • Rofecoxib
  • Rucaparib
  • Secobarbital
  • Segesterone Acetate; Ethinyl Estradiol
  • Simeprevir
  • Sulindac
  • Tacrine
  • Thiabendazole
  • Thiopental
  • tobacco
  • Tolmetin
  • Tuberculin Purified Protein Derivative, PPD
  • Valdecoxib
  • Vemurafenib
  • Zileuton
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