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Kotchetkov R, Drennan IR, Susman D, DiMaria E, Gerard L, Nay D, Prica A. Bendamustine and rituximab is well-tolerated and efficient in the treatment of indolent non-Hodgkin's lymphoma and mantle cell lymphoma in elderly: A single center observational study. Int J Cancer 2023; 152:1884-1893. [PMID: 36545885 DOI: 10.1002/ijc.34412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Bendamustine and rituximab (BR) is a preferred first-line therapy for indolent non-Hodgkin's lymphoma (iNHL) and mantle cell lymphoma (MCL); however, few reports on BR performance in elderly patients are available to date. We compared safety and efficacy of BR in patients ≥70 years (elderly) vs <70 years (younger) treated at our institution. Among 201 patients, 113 were elderly (median age: 77 years), including 38 patients ≥80 years, and 88 were younger (median age: 62 years). Elderly patients had more bone marrow involvement by lymphoma, anemia, ECOG status 3 and high-risk disease follicular lymphoma (P < .05 for all). Fifty-four percent of elderly received full dose of bendamustine vs 79.5% of younger patients. More elderly patients (54%) vs younger (43.2%) experienced treatment delay. Less elderly proceeded to rituximab maintenance. Overall, the number of adverse events per patient and transformed B-Cell lymphoma/secondary malignancies were similar between groups. Elderly patients had less febrile neutropenia, rituximab-associated infusion reactions, but more herpes zoster reactivation. There were more deaths in the elderly (37.2%) vs younger (10.2%) groups (P < .001), mainly due to non-lymphoma-related causes. With median follow-up of 42 months [4.0-97.0] disease-free survival for the elderly was similar to younger patients. There was no difference between patients <80 and ≥80 years (P = .274). In conclusion, the real-world elderly patients have more advanced disease and higher ECOG status. BR is well-tolerated; elderly patients had lower incidence of febrile neutropenia. Dose reduction and treatment delays are common, but BR efficacy was not affected even in very old patients (≥80 years).
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Affiliation(s)
- Rouslan Kotchetkov
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Center, Barrie, Ontario, Canada
| | - Ian R Drennan
- Department of Family and Community Medicine, Temerity Faculty of Medicine, Sunnybrook Research Institute, Sunnybrook Health Science Center, University of Toronto, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Erica DiMaria
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Center, Barrie, Ontario, Canada
| | - Lauren Gerard
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Center, Barrie, Ontario, Canada
| | - Derek Nay
- Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Center, Barrie, Ontario, Canada
| | - Anca Prica
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
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Bullae And Blisters: A Rare Case of Bendamustine Skin Toxicity. Indian J Hematol Blood Transfus 2016; 32:368-9. [PMID: 27408441 DOI: 10.1007/s12288-016-0651-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/19/2016] [Indexed: 10/22/2022] Open
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Mawri S, Nabi S, Jallad B, Won J. Leukaemia cutis after starting bendamustine: cause or coincidence? BMJ Case Rep 2015; 2015:bcr-2014-209025. [PMID: 26392439 DOI: 10.1136/bcr-2014-209025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A 55-year-old man with a history of chronic lymphocytic leukaemia presented with diffuse skin lesions that began 1 week after starting a new chemotherapy regimen with bendamustine and rituximab. The lesions appeared as erythematous papules that were neither itchy nor tender, and did not blanch with pressure. Initially, they began on his scalp and flanks and, over the next few days, spread diffusely throughout his body, becoming darker in colour. Skin biopsy showed atypical clonal B-cell proliferation in a perivascular, periadnexal and dermal band-like distribution, which was further characterised by immunohistochemical evaluation. These findings were suggestive of leukaemia cutis and consistent with the patient's chronic lymphocytic leukaemia, which was previously confirmed by bone marrow biopsy. The bendamustine was stopped and the patient's chemotherapy regimen was switched to fludarabine, cyclophosphamide and rituximab. Shortly thereafter, the leukaemia cutis regressed significantly.
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Affiliation(s)
- Sagger Mawri
- Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Shahzaib Nabi
- Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - Bassel Jallad
- Department of Hematology-Oncology, Saint Louis University, Saint Louis, Missouri, USA
| | - Joseph Won
- Department of Hematology-Oncology, Henry Ford Health System, Detroit, Michigan, USA
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Increased number of peripheral CD8+ T cells but not eosinophils is associated with late-onset skin reactions caused by bendamustine. Int J Hematol 2015; 102:53-8. [PMID: 25833722 DOI: 10.1007/s12185-015-1791-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/17/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
Bendamustine is a chemotherapeutic drug that has recently come to be used frequently in the treatment of indolent B cell lymphomas. Skin toxicity is recognized as one of its characteristic side effects, but detailed information on such reactions has not yet been obtained. To clarify the clinical features of skin toxicity associated with bendamustine, we retrospectively analyzed skin reactions that developed in patients treated with bendamustine and rituximab (BR). Of 34 patients treated with 3-6 cycles of BR, 11 developed late-onset, persistent skin eruptions. These patients demonstrated increases in CD8(+) T cell number and CD8(+):CD4(+) cell ratio at the end of chemotherapy. In contrast, peripheral eosinophil count was not associated with such adverse events, whereas eosinophil infiltration was frequently observed in the skin. Patients with skin reactions tended to have higher seropositivity of hepatitis B core antibody, and multiplex viral screening PCR of the frozen sera demonstrated cytomegalovirus-DNA in some of the eruption-positive patients. It is speculated that inappropriate activation of CD8(+) T cells by latently infected pathogens may be one of the triggers of late-onset skin reactions caused by bendamustine.
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Carilli A, Favis G, Sundharkrishnan L, Hajdenberg J. Severe dermatologic reactions with bendamustine: a case series. Case Rep Oncol 2014; 7:465-70. [PMID: 25120473 PMCID: PMC4127542 DOI: 10.1159/000365324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cutaneous drug reactions make up the largest proportion of adverse events in the medical field. Causality, in particular, is difficult to determine, and therefore, preventing recurrent reactions can be challenging. Bendamustine was initially thought to be a well-tolerated chemotherapy agent with few side effects aside from bone marrow suppression. However, the incidence of cutaneous reactions reported is rising. We describe three such reactions in relation to bendamustine administration in hopes of adding to the awareness of such side effects.
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Affiliation(s)
| | - Gregory Favis
- Halifax Regional Oncology Center, Daytona Beach, Fla., USA
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Jo T, Horio K. Severe Liver Damage and Nonallergic Bronchitis with Eosinophilia in a Patient with Follicular Lymphoma Treated with Bendamustine plus Rituximab. Case Rep Oncol 2014; 7:497-502. [PMID: 25232317 PMCID: PMC4164105 DOI: 10.1159/000365566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A 66-year-old female with follicular lymphoma developed severe liver dysfunction and nonallergic bronchitis after 1 cycle of treatment with bendamustine and rituximab (BR) therapy. Simultaneously, eosinophilia was observed. Further examination revealed negative results for both hepatitis virus-induced liver damage and lymphoma cell invasion into the liver. No bacterial, fungal, or cytomegaloviral infections of the respiratory tract were observed. The patient was treated with steroid pulse therapy followed by prednisolone with complete resolution of her symptoms. This suggests that eosinophilia induced by the treatment with BR may result in liver dysfunction and nonallergic bronchitis.
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Affiliation(s)
- Tatsuro Jo
- Department of Hematology, Japanese Red Cross Society Nagasaki Genbaku Hospital, Nagasaki, Japan
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Sorensen E. Managing patients with indolent lymphoma treated with bendamustine: a nursing perspective. Clin J Oncol Nurs 2013; 17:303-11. [PMID: 23715707 DOI: 10.1188/13.cjon.303-311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Indolent lymphoma is one of the most frequently occurring subtypes of non-Hodgkin lymphoma (NHL). Indolent NHL has a long natural history, and patients will likely receive multiple therapies during the course of their disease. Treatment options are rapidly evolving and, because oncology nurses play a major role in managing patients undergoing treatment for indolent NHL, they need to be aware of the potential adverse effects associated with new therapies that may affect patients in their care. One such agent is bendamustine, which was approved by the U. S. Food and Drug Administration in 2008 for the treatment of relapsed indolent NHL. Oncology nurses are increasingly likely to encounter bendamustine either as monotherapy or in combination with rituximab. Bendamustine is a hybrid agent with both alkylating and purine analog properties, produces a high response rate in patients with indolent NHL, and has manageable side effects that include immunosuppression, gastrointestinal toxicity, and fatigue. Oncology nurses should be familiar with the common side effects so as to provide enhanced care for the patient receiving this agent. This article reviews the safety profile of bendamustine and discusses the implications from a nursing perspective.
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Affiliation(s)
- Elizabeth Sorensen
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center in Houston, USA.
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Korycka-Wołowiec A, Robak T. Pharmacokinetic evaluation and therapeutic activity of bendamustine in B-cell lymphoid malignancies. Expert Opin Drug Metab Toxicol 2012; 8:1455-68. [DOI: 10.1517/17425255.2012.723690] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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