1
|
Agarwal B, Jagdale S, Kadam P, Sakpal P, Nalawade S, Maske S, Dale P. Development and Validation of Stability Indicating RP-HPLC Method for the Estimation of Glycopyrrolate and Neostigmine in Bulk and Injection. J Chromatogr Sci 2024; 62:213-221. [PMID: 37207317 DOI: 10.1093/chromsci/bmad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 03/23/2023] [Indexed: 05/21/2023]
Abstract
A stability indicating RP-HPLC method is suggested for determination of Glycopyrrolate-Neostigmine (GLY/NEO) in bulk drugs and injection formulation. GLY/NEO were eluted from a Chromolith High Resolution RP-18e (100 mm×4.6 mm) with buffer solution (pH 3.0) as mobile phase A and a mixture of HPLC grade acetonitrile and water mixture (90:10) as mobile phase B. The gradient was optimized with a flowrate of 0.5 mL/min and wavelength of 222 nm. A complete analytical method validation was effectively carried out as per ICH Q2 (R1) guidelines. Recovery studies were performed at 50-150% level of working concentrations, and results were in the range of 99-101%. The linearity was detected in the range of LOQ to 200% of the specification limits i.e., 0.5% each for NEO and GLY, 0.01% for NEO Impurity B and 1.0% for rest of the impurities with respect to the test concentration of the respective components. For stability study, various stress conditions such as acid, base, oxidation and thermal as per ICH guidelines were studied. The high recovery and low relative standard deviation confirm the suitability of proposed method that can be employed for the routine analysis in bulk and pharmaceutical formulation.
Collapse
Affiliation(s)
- Babita Agarwal
- Pharmaceutical Quality Assurance, Marathwada Mitra Mandal's College of Pharmacy, Thergaon, Pune, Maharashtra 411033, India
| | - Sachin Jagdale
- Pharmaceutical Quality Assurance, Marathwada Mitra Mandal's College of Pharmacy, Thergaon, Pune, Maharashtra 411033, India
| | - Prasad Kadam
- Pharmaceutical Quality Assurance, Marathwada Mitra Mandal's College of Pharmacy, Thergaon, Pune, Maharashtra 411033, India
| | - Pramod Sakpal
- Pharmaceutical Quality Assurance, Marathwada Mitra Mandal's College of Pharmacy, Thergaon, Pune, Maharashtra 411033, India
| | - Santaji Nalawade
- Callidus Research Laboratories Pvt. Ltd, PAP-A-29/1, Chakan Industrial Area, Phase-IV, Nighoje, Pune, Tal-Khed, Maharashtra 410501, India
| | - Shivraj Maske
- Pharmaceutical Quality Assurance, Marathwada Mitra Mandal's College of Pharmacy, Thergaon, Pune, Maharashtra 411033, India
| | - Pooja Dale
- Pharmaceutical Quality Assurance, Marathwada Mitra Mandal's College of Pharmacy, Thergaon, Pune, Maharashtra 411033, India
| |
Collapse
|
2
|
Purvis KN, Swanson HD, Niloy KK, Zhou Y, Panetta JC, Crews KR, Flerlage JE. Pharmacokinetics and safety of bendamustine in the BEABOVP regimen for the treatment of pediatric patients with Hodgkin lymphoma. Cancer Chemother Pharmacol 2023; 92:1-6. [PMID: 37199744 PMCID: PMC10761213 DOI: 10.1007/s00280-023-04540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE The Stanford V chemotherapy regimen has been used to treat Hodgkin lymphoma (HL) patients since 2002 with excellent cure rates; however, mechlorethamine is no longer available. Bendamustine, a drug structurally similar to alkylating agents and nitrogen mustard, is being substituted for mechlorethamine in combination therapy in a frontline trial for low- and intermediate-risk pediatric HL patients, forming a new backbone of BEABOVP (bendamustine, etoposide, doxorubicin, bleomycin, vincristine, vinblastine, and prednisone). This study evaluated the pharmacokinetics and tolerability of a 180 mg/m2 dose of bendamustine every 28 days to determine factors that may explain this variability. METHODS Bendamustine plasma concentrations were measured in 118 samples from 20 pediatric patients with low- and intermediate-risk HL who received a single-day dose of 180 mg/m2 of bendamustine. A pharmacokinetic model was fit to the data using nonlinear mixed-effects modeling. RESULTS Bendamustine concentration vs time demonstrated a trend toward decreasing clearance with increasing age (p = 0.074) and age explained 23% of the inter-individual variability in clearance. The median (range) AUC was 12,415 (8,539, 18,642) µg hr/L and the median (range) maximum concentration was 11,708 (8034, 15,741) µg/L. Bendamustine was well tolerated with no grade 3 toxicities resulting in treatment delays of more than 7 days. CONCLUSIONS A single-day dose of 180 mg/m2 of bendamustine every 28 days was safe and well tolerated in pediatric patients. While age accounted for 23% of inter-individual variability observed in bendamustine clearance, the differences did not affect the safety and tolerability of bendamustine in our patient population.
Collapse
Affiliation(s)
- Katelyn N Purvis
- University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Hope D Swanson
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kumar Kulldeep Niloy
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Yiwang Zhou
- Department of Biostatistics, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - John C Panetta
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kristine R Crews
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jamie E Flerlage
- Department of Oncology, St. Jude Children's Research Hospital, The University of Tennessee Health Science Center, 262 Danny Thomas Pl, Mailstop 260, Memphis, TN, 38105, USA.
| |
Collapse
|
3
|
Girkar N, Zaki S, Pawar S, Dhande P. Reversible Cardiomyopathy after Rituximab Treatment in a Chronic Lymphocytic Leukemia Patient. J Oncol Pharm Pract 2022; 28:1650-1653. [PMID: 35112937 DOI: 10.1177/10781552221077422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Rituximab is a monoclonal antibody that has shown efficacy in non-Hodgkin's lymphoma, chronic lymphocytic leukemia (CLL), both as a single agent and in combination with traditional chemotherapies. CASE REPORT Here, we present a case wherein a 56-year-old man developed dilated cardiomyopathy following one cycle of rituximab and bendamustine chemotherapy protocol used to treat chronic lymphocytic leukemia. On the fifth day the patient developed hypotensive shock followed closely by the development of cough after two days. MANAGEMENT AND OUTCOME The patient was started on carvedilol 3.125 mg, ramipril 2.5 mg, and torsemide 5 mg for treatment of cardiomyopathy. Blood transfusion was necessary for hypotensive shock. Antibiotic regimen was started for sepsis and progressive cough. The patient recovered fully from all the symptoms. DISCUSSION This case illustrates the potential for cardiomyopathy with rituximab, particularly in patients with chronic lymphocytic leukemia, and its proposed mechanisms and treatment. The expanding utility of rituximab impels us to increase monitoring and awareness of this serious cardiovascular adverse effect.
Collapse
Affiliation(s)
- Nishat Girkar
- Department of Clinical Pharmacy, 76012Poona College of Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Saba Zaki
- Department of Clinical Pharmacy, 76012Poona College of Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Sunita Pawar
- Assistant professor, 76012Poona College of Pharmacy, Bharati Vidyapeeth University, Pune, Maharashtra, India
| | - Priti Dhande
- Department of Pharmacology, Bharati Vidyapeeth University Medical College and Hospital, Pune, Maharashtra, India
| |
Collapse
|
4
|
Farag S, Jeker B, Bacher U, Mansouri Taleghani B, Mueller BU, Novak U, Pabst T. Dose-intensified bendamustine and melphalan (BenMel) conditioning before second autologous transplantation in myeloma patients. Hematol Oncol 2018; 36:671-678. [PMID: 30110717 DOI: 10.1002/hon.2546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 12/13/2022]
Abstract
Consolidation in myeloma patients with high-dose melphalan chemotherapy (Mel HDCT) and autologous transplantation (ASCT) is standard of care since more than 2 decades. However, definite cure remains exceptional despite intensive treatment, and improving effectiveness of HDCT remains an unmet clinical need. Combining intensified bendamustine with melphalan may represent an option. We analyzed safety and efficacy of combining dose-intensified bendamustine (200 mg/m2 on days -4/-3) with high-dose melphalan (100 mg/m2 on days -2/-1) before a second (tandem) ASCT in adverse risk myeloma patients after Mel HDCT/ASCT1. Twelve patients received BenMel conditioning before ASCT2 because of high-risk cytogenetics and/or failure to achieve complete remission (CR) after Mel HDCT/ASCT1. Comparing Mel HDCT/ASCT1 and BenMel HDCT/ASCT2, we observed no differences in hematologic recovery and tolerance. Acute renal injury after BenMel conditioning occurred in 3 (25%) patients, but was reversible in all patients, and there were no treatment related deaths. Complete remission rates were increasing from 42% after Mel/ASCT1 to 75% after BenMel/ASCT2. PFS 1 year after ASCT2 was 67%, and OS was 83%. These data suggest that dose-intensified bendamustine with melphalan conditioning is safe and warrants a prospective randomized comparison to standard melphalan HDCT in myeloma patients.
Collapse
Affiliation(s)
- Sarah Farag
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Barbara Jeker
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Ulrike Bacher
- Department of Hematology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Beatrice U Mueller
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Comparable safety profile of BeEAM (bendamustine, etoposide, cytarabine, melphalan) and BEAM (carmustine, etoposide, cytarabine, melphalan) as conditioning before autologous haematopoietic cell transplantation. Contemp Oncol (Pozn) 2018; 22:113-117. [PMID: 30150889 PMCID: PMC6103227 DOI: 10.5114/wo.2018.77046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 03/26/2018] [Indexed: 11/27/2022] Open
Abstract
Introduction BEAM (carmustine, etoposide, cytarabine, melphalan) is the most frequently used high-dose chemotherapy regimen for patients with lymphoma referred for autologous haematopoietic cell transplantation (autoHCT). Recently, a novel conditioning protocol containing bendamustine instead of carmustine (BeEAM) has been proposed to potentially increase the efficacy. Aim of the study The aim of this study was to retrospectively compare the safety profile of BEAM and BeEAM based on single-centre experience. Material and methods A total of 237 consecutive patients with lymphoma treated with either BEAM (n = 174) or BeEAM (n = 63), between the years 2011 and 2016, were included in the analysis. Clinical characteristics of both groups were comparable. Patients with Hodgkin’s lymphoma (HL) constituted 49% of the BEAM group and 40% of the BeEAM group. Results Median time to neutrophil > 0.5 × 109/l recovery was 10 days in both groups (p = 0.29), while median time to platelet > 50 × 109/l recovery was 13 and 14 days after BEAM and BeEAM, respectively (p = 0.12). The toxicity profile was comparable except for arterial hypertension and severe hypokalaemia, which occurred more frequently after BeEAM compared to BEAM (p = 0.02 and p = 0.004, respectively). The rate of early mortality was 1.7% and 1.6%, respectively. The probabilities of the overall and progression-free survival were comparable for both groups (p = 0.73 and p = 0.55, respectively). Conclusions Administration of bendamustine instead of carmustine as part of conditioning does not affect the engraftment or the toxicity profile of the regimen. Therefore, BeEAM may be safely used in patients with lymphoma undergoing autoHCT. Its efficacy requires evaluation in prospective studies.
Collapse
|
6
|
Chantepie SP, Garciaz S, Tchernonog E, Peyrade F, Larcher M, Diouf M, Fornecker L, Houot R, Gastinne T, Soussain C, Malak S, Lemal R, Delette C, Ibrahim A, Gac A, Reboursière E, Vilque J, Bekadja M, Casasnovas R, Gressin R, Guidez S, Coso D, Herbaux C, Yakoub‐Agha I, Bouabdallah K, Durot E, Damaj G. Bendamustine-based conditioning prior to autologous stem cell transplantation (ASCT): Results of a French multicenter study of 474 patients from LYmphoma Study Association (LYSA) centers. Am J Hematol 2018; 93:729-735. [PMID: 29473209 DOI: 10.1002/ajh.25077] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/28/2018] [Accepted: 02/21/2018] [Indexed: 11/06/2022]
Abstract
Carmustine shortage has led to an increase use of alternative conditioning regimens prior to autologous stem cell transplantation for the treatment of lymphoma, including Bendamustine-based (BeEAM). The aim of this study was to evaluate the safety of the BeEAM regimen in a large cohort of patients. A total of 474 patients with a median age of 56 years were analyzed. The majority of patients had diffuse large B-cell lymphoma (43.5%). Bendamustine was administered at a median dose of 197 mg/m2 /day (50-250) on days-7 and -6. The observed grade 1-4 toxicities included mucositis (83.5%), gastroenteritis (53%), skin toxicity (34%), colitis (29%), liver toxicity (19%), pneumonitis (5%), and cardiac rhythm disorders (4%). Nonrelapse mortality (NRM) was reported in 3.3% of patients. Acute renal failure (ARF) was reported in 132 cases (27.9%) (G ≥2; 12.3%). Organ toxicities and death were more frequent in patients with post conditioning renal failure. In a multivariate analysis, pretransplant chronic renal failure, bendamustine dose >160 mg/m2 and age were independent prognostic factors for ARF. Pretransplant chronic renal failure, hyperhydration volume, duration of hyperhydration, and etoposide dose were predictive factors of NRM. A simple, four-point scoring system can stratify patients by levels of risk for ARF and may allow for a reduction in the bendamustine dose to avoid toxicity. Drugs shortage may have dangerous consequences. Prospective, comparative studies are needed to confirm the toxicity/efficacy extents from this conditioning regimen compared to other types of high dose therapy.
Collapse
Affiliation(s)
| | | | | | | | | | - Momar Diouf
- Clinical Research DepartmentAmiens University hospitalAmiensEA4666 France
| | | | - Roch Houot
- Hematology, University hospitalRennes France
| | - Thomas Gastinne
- Department of HematologyNantes University HospitalNantes France
| | - Carole Soussain
- Department of HematologyCurie Institute, Hôpital René HugueninSaint‐Cloud France
| | - Sandra Malak
- Department of HematologyCurie Institute, Hôpital René HugueninSaint‐Cloud France
| | - Richard Lemal
- Service d'hématologie clinique adulte et de thérapie cellulaire, CHU ESTAING, EA 7453 CHELTER, Université Clermont Auvergne CIC‐501Clermont‐Ferrand France
| | | | | | | | | | - Jean‐Pierre Vilque
- Institut d'Hématologie de Basse‐Normandie, Centre François BaclesseCaen France
| | - Mohamed‐Amine Bekadja
- Hematology and Cell TherapyEtablissement Hospitalier Universitaire (EHU) 1st NovemberOran Algeria
| | | | | | - Stéphanie Guidez
- Oncologie hématologique et thérapie cellulaire, CHU PoitiersPoitiers France
| | - Diane Coso
- Department of HematologyInstitut Paoli CalmettesMarseille
| | - Charles Herbaux
- Hematology, Hôpital HURIEZ UAM allogreffe de CSH, CHRULille France
| | | | | | - Eric Durot
- Department of HematologyCentre Hospitalier UniversitaireReims Cedex FRA
| | - Gandhi Damaj
- Institut d'Hématologie de Basse‐Normandie, CHUCaen France
- Microenvironnement Cellulaire et Pathologies, Normandie Univ, UnicaenMILPAT Caen14000 France
| |
Collapse
|
7
|
Pereira TS, Sant'anna JRD, Morais JF, Yajima JPRDS, Mathias PCDF, Franco CCDS, Castro-Prado MAAD. Assessment of bendamustine-induced genotoxicity in eukaryotic cells. Drug Chem Toxicol 2018; 42:394-402. [PMID: 29681187 DOI: 10.1080/01480545.2018.1458236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Bendamustine, an anticancer drug with alkylating properties, is widely used to treat hematological malignancies. Since the nitrogen mustard family alkylators induce DNA damages and have been associated with an elevated risk of second malignancy, current study evaluates the cytotoxic, mutagenic, and recombinogenic effects of bendamustine by using, respectively the mitotic index assay, the in vitro mammalian cell micronucleus test (Mnvit) and the chromosome aberration (CA) test in human peripheral lymphocytes, and the in vivo homozygotization assay in Aspergillus nidulans, which detects the loss of heterozygosity (LOH) due to somatic recombination. Bendamustine (6.0 µg/ml, 9.0 µg/ml, and 12.0 µg/ml) induced a statistically significant concentration-related increase in the frequencies of micronuclei and a significant reduction in the cytokinesis block proliferation index (CBPI) rates when compared to negative control. In the CA test, bendamustine significantly increased the frequencies of structural aberrations at the three tested concentrations when compared to the negative control. Aspergillus nidulans diploids, obtained after bendamustine treatment (6.0 µg/ml, 12.0 µg/ml, and 24.0 µg/ml), produced, after haploidization, homozygotization index (HI) rates higher than 2.0 and significantly different from the negative control. Since bendamustine showed genotoxic effects in all tested concentrations, two of them corresponding to the peak plasma concentrations observed in cancer patients treated with bendamustine, data provided in the current research work may be useful to identify the most appropriate dosage regimen to achieve the efficacy and safety of this anticancer medication.
Collapse
Affiliation(s)
- Tais Susane Pereira
- a Departamento de Biotecnologia, Genética e Biologia Celular , Universidade Estadual de Maringá , Maringá , Paraná , Brazil
| | - Juliane Rocha de Sant'anna
- a Departamento de Biotecnologia, Genética e Biologia Celular , Universidade Estadual de Maringá , Maringá , Paraná , Brazil
| | - Janicelle Fernandes Morais
- a Departamento de Biotecnologia, Genética e Biologia Celular , Universidade Estadual de Maringá , Maringá , Paraná , Brazil
| | | | - Paulo Cezar de Freitas Mathias
- a Departamento de Biotecnologia, Genética e Biologia Celular , Universidade Estadual de Maringá , Maringá , Paraná , Brazil
| | | | | |
Collapse
|
8
|
Gordon MJ, Lewis LD, Brown JR, Danilov AV. Bendamustine hydrochloride in patients with B-cell malignancies who have comorbidities - is there an optimal dose? Expert Rev Hematol 2017; 10:707-718. [PMID: 28664772 DOI: 10.1080/17474086.2017.1350166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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.
Collapse
Affiliation(s)
- Max J Gordon
- a Department of Internal Medicine , Oregon Health & Science University , Portland , OR , USA
| | - Lionel D Lewis
- b Section of Clinical Pharmacology, Department of Medicine , The Geisel School of Medicine at Dartmouth and The Norris Cotton Cancer Center , Lebanon , NH , USA
| | - Jennifer R Brown
- c Department of Medical Oncology , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Alexey V Danilov
- a Department of Internal Medicine , Oregon Health & Science University , Portland , OR , USA.,d Knight Cancer Institute , Oregon Health & Science University , Portland , OR , USA
| |
Collapse
|
9
|
Modi P, Balakrishnan K, Yang Q, Wierda WG, Keating MJ, Gandhi V. Idelalisib and bendamustine combination is synergistic and increases DNA damage response in chronic lymphocytic leukemia cells. Oncotarget 2017; 8:16259-16274. [PMID: 28187444 PMCID: PMC5369961 DOI: 10.18632/oncotarget.15180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022] Open
Abstract
Idelalisib is a targeted agent that potently inhibits PI3Kδ which is exclusively expressed in hematological cells. Bendamustine is a well-tolerated cytotoxic alkylating agent which has been extensively used for treatment of chronic lymphocytic leukemia (CLL). Both these agents are FDA-approved for CLL. To increase the potency of idelalisib and bendamustine, we tested their combination in primary CLL lymphocytes. While each compound alone produced a moderate response, combination at several concentrations resulted in synergistic cytotoxicity. Idelalisib enhanced the bendamustine-mediated DNA damage/repair response, indicated by the phosphorylation of ATM, Chk2, and p53. Each drug alone activated γH2AX but combination treatment further increased the expression of this DNA damage marker. Compared with the control, idelalisib treatment decreased global RNA synthesis, resulting in a decline of early-response and short-lived MCL1 transcripts. In concert, there was a decline in total Mcl-1 protein in CLL lymphocytes. Isogenic mouse embryonic fibroblasts lacking MCL1 had higher sensitivity to bendamustine alone or in combination compared to MCL1 proficient cells. Collectively, these data indicate that bendamustine and idelalisib combination therapy should be investigated for treating patients with CLL.
Collapse
Affiliation(s)
- Prexy Modi
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kumudha Balakrishnan
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qingshan Yang
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael J Keating
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Varsha Gandhi
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
10
|
Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: a review. Bone Marrow Transplant 2017; 52:941-949. [DOI: 10.1038/bmt.2016.340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 11/08/2016] [Accepted: 11/16/2016] [Indexed: 11/08/2022]
|
11
|
Danilov AV, Lewis LD, Lansigan F, Roudaia L, Findley DL, Jones SY, Highhouse B, Beaulieu BB, Brown JR. A phase I dose-ranging study of bendamustine and rituximab in chronic lymphocytic leukemia patients with comorbidities. Br J Haematol 2016; 178:820-823. [PMID: 27377970 DOI: 10.1111/bjh.14171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alexey V Danilov
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Lionel D Lewis
- Department of Medicine, Geisel School of Medicine and the Norris Cotton Cancer Center at Dartmouth, Lebanon, NH, USA
| | - Frederick Lansigan
- Department of Medicine, Geisel School of Medicine and the Norris Cotton Cancer Center at Dartmouth, Lebanon, NH, USA
| | - Liya Roudaia
- Department of Medicine, Geisel School of Medicine and the Norris Cotton Cancer Center at Dartmouth, Lebanon, NH, USA
| | - Darcie L Findley
- Department of Medicine, Geisel School of Medicine and the Norris Cotton Cancer Center at Dartmouth, Lebanon, NH, USA
| | - Susan Y Jones
- Department of Medicine, Geisel School of Medicine and the Norris Cotton Cancer Center at Dartmouth, Lebanon, NH, USA
| | - Brian Highhouse
- Department of Medicine, Geisel School of Medicine and the Norris Cotton Cancer Center at Dartmouth, Lebanon, NH, USA
| | - Bernard B Beaulieu
- Department of Medicine, Geisel School of Medicine and the Norris Cotton Cancer Center at Dartmouth, Lebanon, NH, USA
| | | |
Collapse
|
12
|
Plenis A, Frolow A, Rekowska N, Olędzka I, Kowalski P, Bień E, Krawczyk MA, Adamkiewicz-Drożynska E, Bączek T. Determination of Bendamustine in Human Plasma and Urine by LC-FL Methods: Application in a Drug Monitoring. Chromatographia 2016; 79:861-873. [PMID: 27429473 PMCID: PMC4930483 DOI: 10.1007/s10337-016-3103-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/28/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Abstract
Simple and sensitive liquid chromatography (LC) methods with fluorescence (FL) detection for the determination of bendamustine (BM) in human plasma and urine were developed and validated. The procedure of BM extraction from a plasma sample involved solid-phase extraction with a C18 SPE column, while liquid–liquid extraction with dichloromethane was applied for a urine sample. In both methods, cinoxacin was used as the internal standard. Chromatographic separations were performed on a Synergi Max-RP column, while FL detector was set at the excitation wavelength of 328 nm and the emission wavelength of 420 nm. The LC-FL methods were validated for accuracy, precision, selectivity, linearity, recovery, and stability. The detection limits for BM were 0.5 and 2.5 ng mL−1 in plasma and urine, respectively. The intra-day and inter-day precisions were less than 9.86 %, while the accuracies were higher than 92.63 and 94.29 % for BM in plasma and urine, respectively. The proposed LC-FL methods were sensitive, robust, and specific, allowing reliable drug quantification in plasma and urine samples. The methodologies were successfully applied to monitoring of BM in a child with cancer treated with BM.
Collapse
Affiliation(s)
- Alina Plenis
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Agnieszka Frolow
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Natalia Rekowska
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Ilona Olędzka
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Piotr Kowalski
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| | - Ewa Bień
- Department of Pediatris, Hematology and Oncology; Medical University Gdansk, Debinki 7, 80-11 Gdansk, Poland
| | - Małgorzata Anna Krawczyk
- Department of Pediatris, Hematology and Oncology; Medical University Gdansk, Debinki 7, 80-11 Gdansk, Poland
| | | | - Tomasz Bączek
- Department of Pharmaceutical Chemistry, Medical University of Gdansk, Hallera 107, 80-416 Gdansk, Poland
| |
Collapse
|
13
|
Martino M, Tripepi G, Messina G, Vincelli ID, Console G, Recchia AG, Gentile M, Molica S, Morabito F. A phase II, single-arm, prospective study of bendamustine plus melphalan conditioning for second autologous stem cell transplantation in de novo multiple myeloma patients through a tandem transplant strategy. Bone Marrow Transplant 2016; 51:1197-203. [DOI: 10.1038/bmt.2016.94] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/27/2016] [Accepted: 02/26/2016] [Indexed: 11/09/2022]
|
14
|
Phase I/IIa study of sequential chemotherapy regimen of bendamustine/irinotecan followed by etoposide/carboplatin in untreated patients with extensive disease small cell lung cancer (EDSCLC). Cancer Chemother Pharmacol 2015; 76:949-55. [PMID: 26395450 DOI: 10.1007/s00280-015-2869-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The sequence bendamustine (B) + Irinotecan (I) followed by etoposide (E) + carboplatin (C) was hypothesized to increase progression-free survival (PFS) and overall survival (OS) in untreated extensive-disease small cell lung cancer (EDSCLC) patients compared to historical controls by exploiting mitotic catastrophe. Absent expression of ERCC-1 and expression of topoisomerases were hypothesized to be predictive for PFS and OS. METHODS This was a phase I/IIa trial in 30 patients to determine the maximum tolerated dose (MTD) of B + I and the PFS of B + I E + C with secondary end points including overall response rate (ORR) and OS. Biomarkers measured by immunohistochemistry (IHC) obtained from diagnostic specimens were correlated with outcome. RESULTS The MTD of B + I was not reached. During treatment with B + I, there were two grade 5 toxicities from neutropenic sepsis and metabolic encephalopathy. Other toxicities included fatigue, nausea/vomiting, diarrhea, and weight loss. For the sequence, the PFS and OS were 6.0 months and 10 months, respectively. The ORR for B + I and the sequence were 82% and 83%, respectively. Topoisomerase-2 expression was predictive for TTP and OS, but absent ERCC-1 expression was not, contrary to our hypothesis. CONCLUSIONS B + I is an active regimen in EDSCLC. Toxicities included two grade 5 events but were otherwise manageable. The novel sequence B + I E + C increased PFS and OS compared to historical controls. Correlative studies are conflicting regarding the mechanism of action of this novel sequence.
Collapse
|
15
|
Pan E, Yu D, Zhao X, Neuger A, Smith P, Chinnaiyan P, Yu HHM. Phase I study of bendamustine with concurrent whole brain radiation therapy in patients with brain metastases from solid tumors. J Neurooncol 2014; 119:413-20. [PMID: 24965340 DOI: 10.1007/s11060-014-1510-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/16/2014] [Indexed: 12/25/2022]
Abstract
A phase I study was conducted to evaluate the dose-limiting toxicities (DLTs) and to determine the maximum tolerated dose (MTD)/recommended phase II dose of bendamustine with concurrent whole brain radiation (WBR) in patients with brain metastases (BM) from solid tumors. Four doses of intravenous weekly bendamustine were administered with 3 weeks of WBR at three dose levels (60, 80, and 100 mg/m(2)) according to a standard 3 + 3 phase I design. A total of 12 patients with solid tumor BM were enrolled in the study (six with non-small cell lung cancer, four with melanoma, one with breast cancer, and one with neuroendocrine carcinoma). The first two dose levels had three patients each, and the third dose level had six total patients. Plasma pharmacokinetic studies of bendamustine demonstrated no significant differences from pharmacokinetic characteristics of bendamustine in other studies. No DLTs were noted at any dose levels, and no grade 4 toxicities occurred. The MTD of weekly bendamustine with concurrent WBR was 100 mg/m(2). The majority of trial patients died from progressive systemic disease rather than their brain disease. The combination of weekly bendamustine with concurrent WBR was acceptably tolerated. The efficacy of this combination may be evaluated in a phase II trial with stratification by histologies.
Collapse
Affiliation(s)
- Edward Pan
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 5323 Harry Hines Blvd. ND3.300A, Dallas, TX, 75390-9186, USA,
| | | | | | | | | | | | | |
Collapse
|
16
|
Simultaneous determination of bendamustine and its active metabolite, gamma-hydroxy-bendamustine in human plasma and urine using HPLC-fluorescence detector: Application to a pharmacokinetic study in Chinese cancer patients. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 960:98-104. [DOI: 10.1016/j.jchromb.2014.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/02/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022]
|
17
|
Hiraoka N, Kikuchi J, Yamauchi T, Koyama D, Wada T, Uesawa M, Akutsu M, Mori S, Nakamura Y, Ueda T, Kano Y, Furukawa Y. Purine analog-like properties of bendamustine underlie rapid activation of DNA damage response and synergistic effects with pyrimidine analogues in lymphoid malignancies. PLoS One 2014; 9:e90675. [PMID: 24626203 PMCID: PMC3953125 DOI: 10.1371/journal.pone.0090675] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/04/2014] [Indexed: 11/18/2022] Open
Abstract
Bendamustine has shown considerable clinical activity against indolent lymphoid malignancies as a single agent or in combination with rituximab, but combination with additional anti-cancer drugs may be required for refractory and/or relapsed cases as well as other intractable tumors. In this study, we attempted to determine suitable anti-cancer drugs to be combined with bendamustine for the treatment of mantle cell lymphoma, diffuse large B-cell lymphoma, aggressive lymphomas and multiple myeloma, all of which are relatively resistant to this drug, and investigated the mechanisms underlying synergism. Isobologram analysis revealed that bendamustine had synergistic effects with alkylating agents (4-hydroperoxy-cyclophosphamide, chlorambucil and melphalan) and pyrimidine analogues (cytosine arabinoside, gemcitabine and decitabine) in HBL-2, B104, Namalwa and U266 cell lines, which represent the above entities respectively. In cell cycle analysis, bendamustine induced late S-phase arrest, which was enhanced by 4-hydroperoxy-cyclophosphamide, and potentiated early S-phase arrest by cytosine arabinoside (Ara-C), followed by a robust increase in the size of sub-G1 fractions. Bendamustine was able to elicit DNA damage response and subsequent apoptosis faster and with shorter exposure than other alkylating agents due to rapid intracellular incorporation via equilibrative nucleoside transporters (ENTs). Furthermore, bendamustine increased the expression of ENT1 at both mRNA and protein levels and enhanced the uptake of Ara-C and subsequent increase in Ara-C triphosphate (Ara-CTP) in HBL-2 cells to an extent comparable with the purine analog fludarabine. These purine analog-like properties of bendamustine may underlie favorable combinations with other alkylators and pyrimidine analogues. Our findings may provide a theoretical basis for the development of more effective bendamustine-based combination therapies.
Collapse
Affiliation(s)
- Nobuya Hiraoka
- Division of Stem Cell Regulation, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Jiro Kikuchi
- Division of Stem Cell Regulation, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takahiro Yamauchi
- Division of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Daisuke Koyama
- Division of Stem Cell Regulation, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Taeko Wada
- Division of Stem Cell Regulation, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mitsuyo Uesawa
- Department of Hematology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Miyuki Akutsu
- Department of Hematology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Shigehisa Mori
- Medical Education Center, Saitama Medical University, Moroyama, Saitama, Japan
| | - Yuichi Nakamura
- Department of Hematology, Saitama Medical University, Moroyama, Saitama, Japan
| | - Takanori Ueda
- Division of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Yasuhiko Kano
- Department of Hematology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Yusuke Furukawa
- Division of Stem Cell Regulation, Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
- * E-mail:
| |
Collapse
|
18
|
Dubbelman AC, Rosing H, Darwish M, D'Andrea D, Bond M, Hellriegel E, Robertson P, Beijnen JH, Schellens JHM. Pharmacokinetics and excretion of 14C-bendamustine in patients with relapsed or refractory malignancy. Drugs R D 2014; 13:17-28. [PMID: 23322528 PMCID: PMC3627029 DOI: 10.1007/s40268-012-0001-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bendamustine is an alkylating agent with clinical activity against a variety of hematologic malignancies and solid tumors. To assess the roles of renal and hepatic drug elimination pathways in the excretion and metabolism of bendamustine, a mass balance study was performed in patients with relapsed or refractory malignancies. METHODS A single 60-minute intravenous dose of 120 mg/m(2), 80-95 μCi (14)C-bendamustine hydrochloride was administered to six patients, followed by collection of blood, urine, and fecal samples at specified time points up to day 8 or until the radioactivity of the 24-hour urine and fecal collections was below 1% of the administered dose (whichever was longer). Total radioactivity (TRA) was measured in all samples, and concentrations of unchanged bendamustine and its metabolites γ-hydroxy-bendamustine (M3), N-desmethyl-bendamustine (M4), and dihydroxy bendamustine (HP2) were determined in plasma and urine, using validated liquid chromatography-tandem mass spectrometry methods. RESULTS The mean recovery of TRA in excreta was 76% of the radiochemical dose. Approximately half of the administered dose was recovered in urine and a quarter in feces. Less than 5% of the administered dose was recovered in urine as unchanged bendamustine. Bendamustine clearance from plasma was rapid, with a half-life of ~40 minutes. Plasma concentrations of M3, M4, and HP2 were very low relative to bendamustine concentrations. Plasma levels of TRA were higher and more sustained as compared with plasma concentrations of bendamustine, M3, M4, and HP2, suggesting the presence of one or more longer-lived (14)C-bendamustine-derived compounds. Fatigue (50%) and vomiting (50%) were the most frequent treatment-related adverse events. A grade 3/4 absolute lymphocyte count decrease occurred in all patients at some point during the study. CONCLUSION Bendamustine is extensively metabolized, with subsequent excretion in both urine and feces. Accumulation of bendamustine is not anticipated in cancer patients with renal or hepatic impairment, because of the dose administration schedule and short half-life.
Collapse
|
19
|
van der Jagt R. Bendamustine for indolent non-Hodgkin lymphoma in the front-line or relapsed setting: a review of pharmacokinetics and clinical trial outcomes. Expert Rev Hematol 2014; 6:525-37. [DOI: 10.1586/17474086.2013.841538] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
20
|
Kasa S, Raja Sekhar Reddy M, Kadaboina RS, Murki V, Mulukutla VS. Stability-Indicating LC Method for the Estimation of Bendamustine Hydrochloride and its Related Impurities. J Chromatogr Sci 2013; 52:573-83. [DOI: 10.1093/chromsci/bmt075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
21
|
He L, Grecula JC, Ling Y, Enzerra MD, Ammirati M, Kendra K, Cavaliere R, Mayr N, McGregor J, Olencki T, Mrozek E, Matharbootham M, Oluigbo C, Phelps MA. Development and validation of sensitive liquid chromatography/tandem mass spectrometry method for quantification of bendamustine in mouse brain tissue. J Chromatogr B Analyt Technol Biomed Life Sci 2012; 905:141-4. [PMID: 22925718 PMCID: PMC3856370 DOI: 10.1016/j.jchromb.2012.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 08/08/2012] [Accepted: 08/10/2012] [Indexed: 01/09/2023]
Abstract
A liquid chromatography-tandem mass spectrometry method for quantification of bendamustine in mouse brain tissue was developed and fully validated. Methanol was used to precipitate proteins in brain tissue. Bendamustine and internal standard (chlorambucil) were separated with reverse-phase chromatography on a C-18 column with a gradient of water and 95% methanol in 0.1% formic acid. Positive mode electrospray ionization was applied with selected reaction monitoring to achieve 5 ng/ml lower limits of quantitation in mouse brain tissue. The calibration curve for bendamustine in mouse brain was linear between 5 and 2000 ng/ml. The within- and between-batch accuracy and precision of the assay were within 15% at 10, 100 and 1000 ng/ml. The recovery and matrix effect of bendamustine in mouse brain tissue ranged from 41.1% to 51.6% and 107.4% to 110.3%, respectively. The validated method was then applied to quantitate bendamustine in an animal study. Results indicate the assay can be applied to evaluate bendamustine disposition in mouse brain tissue. This assay will be applied in the future to detect and quantify bendamustine in human brain tissue samples.
Collapse
Affiliation(s)
- Lei He
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - John C. Grecula
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Radiation Oncology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Yonghua Ling
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Michael D. Enzerra
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, Ohio
| | - Mario Ammirati
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Neurosurgery, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kari Kendra
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Robert Cavaliere
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Neurosurgery, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nina Mayr
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Radiation Oncology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - John McGregor
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Neurosurgery, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Thomas Olencki
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Ewa Mrozek
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mani Matharbootham
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Anesthesiology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Chima Oluigbo
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Department of Neurosurgery, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Mitch A. Phelps
- Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus, Ohio
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| |
Collapse
|
22
|
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]
|
23
|
Rigacci L, Puccini B, Cortelazzo S, Gaidano G, Piccin A, D’Arco A, Freilone R, Storti S, Orciuolo E, Zinzani PL, Zaja F, Bongarzoni V, Balzarotti M, Rota-Scalabrini D, Patti C, Gobbi M, Carpaneto A, Liberati AM, Bosi A, Iannitto E. Bendamustine with or without rituximab for the treatment of heavily pretreated non-Hodgkin’s lymphoma patients. Ann Hematol 2012; 91:1013-22. [DOI: 10.1007/s00277-012-1422-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 01/31/2012] [Indexed: 10/14/2022]
|
24
|
BeEAM (bendamustine, etoposide, cytarabine, melphalan) before autologous stem cell transplantation is safe and effective for resistant/relapsed lymphoma patients. Blood 2011; 118:3419-25. [PMID: 21816830 DOI: 10.1182/blood-2011-04-351924] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We designed a phase 1-2 study to evaluate the safety and the efficacy of increasing doses of bendamustine (160 mg/m², 180 mg/m², and 200 mg/m² given on days -7 and -6) coupled with fixed doses of etoposide, cytarabine, and melphalan (BeEAM regimen) as the conditioning regimen to autologous stem cell transplantation for resistant/relapsed lymphoma patients. Forty-three patients (median age, 47 years) with non-Hodgkin (n = 28) or Hodgkin (n = 15) lymphoma were consecutively treated. Nine patients entered the phase 1 study; no patients experienced a dose-limiting toxicity. Thirty-four additional patients were then treated in the phase 2. A median number of 6 × 10⁶ CD34(+) cells/kg (range, 2.4-15.5) were reinfused. All patients engrafted, with a median time to absolute neutrophil count > 0.5 × 10⁹/L of 10 days. The 100-day transplantation-related mortality was 0%. After a median follow-up of 18 months, 35 of 43 patients (81%) are in complete remission, whereas 6 of 43 relapsed and 2 of 43 did not respond. Disease type (non-Hodgkin lymphomas vs Hodgkin disease) and disease status at transplantation (chemosensitive vs chemoresistant) significantly influenced DFS (P = .01; P = .007). Remarkably, 4 of 43 (9%) patients achieved the first complete remission after receiving the high-dose therapy with autologous stem cell transplantation. In conclusion, the new BeEAM regimen is safe and effective for heavily pretreated lymphoma patients. The study was registered at European Medicines Agency (EudraCT number 2008-002736-15).
Collapse
|
25
|
Furukawa Y, Hiraoka N, Wada T, Kikuchi J, Kano Y. [Mechanisms of action and clinical effectiveness of the newly approved anti-cancer drug bendamustine]. Nihon Yakurigaku Zasshi 2011; 138:26-32. [PMID: 21747206 DOI: 10.1254/fpj.138.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
26
|
Ogura M, Ando K, Taniwaki M, Watanabe T, Uchida T, Ohmachi K, Matsumoto Y, Tobinai K. Feasibility and pharmacokinetic study of bendamustine hydrochloride in combination with rituximab in relapsed or refractory aggressive B cell non-Hodgkin’s lymphoma6. Cancer Sci 2011; 102:1687-92. [DOI: 10.1111/j.1349-7006.2011.01994.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
27
|
Tageja N. Bendamustine: safety and efficacy in the management of indolent non-hodgkins lymphoma. Clin Med Insights Oncol 2011; 5:145-56. [PMID: 21695099 PMCID: PMC3117628 DOI: 10.4137/cmo.s6085] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Bendamustine (Treanda, Ribomustin) was recently approved by the US Food and Drug Administration (FDA) for treatment of patients with rituximab refractory indolent lymphoma and is expected to turn into a frontline therapy option for indolent lymphoma. This compound with amphoteric properties was designed in the former Germany Democratic Republic in 1960s and re-discovered in 1990s with multiple successive well-designed studies. Bendamustine possesses a unique mechanism of action with potential antimetabolite properties, and only partial cross-resistance with other alkylators. Used in combination with rituximab in vitro, bendamustine shows synergistic effects against various leukemia and lymphoma cell lines. In clinical studies, bendamustine plus rituximab is highly effective in patients with relapsed-refractory indolent lymphoma, inducing remissions in 90% or more and a median progression-free survival of 23-24 months. The optimal dosing and schedule of bendamustine administration is largely undecided and varies among studies. Results of ongoing trials and dose-finding studies will help to further help ascertain the optimal place of bendamustine in the management of indolent NHL.
Collapse
Affiliation(s)
- Nishant Tageja
- Department of Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| |
Collapse
|
28
|
Garnock-Jones KP. Bendamustine: a review of its use in the management of indolent non-Hodgkin's lymphoma and mantle cell lymphoma. Drugs 2010; 70:1703-18. [PMID: 20731477 DOI: 10.2165/11205860-000000000-00000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Bendamustine (bendamustine hydrochloride) is an alkylating agent indicated in several countries for the treatment of indolent non-Hodgkin's lymphoma (NHL) and mantle cell lymphoma (MCL). While the precise mechanism of action of bendamustine is as yet unknown, it has limited cross resistance to other alkylating agents and appears to exert its antineoplastic effects via a different mechanism to that of other alkylating agents. Bendamustine monotherapy was effective in treatment-refractory (including rituximab-refractory) indolent NHL or MCL. Moreover, bendamustine-based combination treatment was at least as effective as cyclophosphamide-based treatment, and bendamustine plus rituximab was at least as effective as cyclophosphamide, doxorubicin, vincristine plus prednisone (CHOP) plus rituximab, as first-line therapy in patients with indolent NHL or MCL. Treatment-refractory disease also appeared to respond favourably to bendamustine-containing combination treatment. In general, bendamustine was associated with a high overall response rate and a durable response. The most common adverse events associated with bendamustine were haematological or gastrointestinal in nature, and most were of mild to moderate severity. Regimens that included bendamustine were also associated with a very low rate of alopecia compared with regimens that included other antineoplastic drugs. In conclusion, bendamustine is a unique alkylating agent, which in clinical trials has demonstrated consistent efficacy and acceptable tolerability in patients with indolent NHL or MCL. It may be a particularly useful treatment option in patients with rituximab-refractory disease, but has also demonstrated efficacy as part of a first-line combination treatment. While further research is necessary to firmly establish the best place for bendamustine in the management of indolent NHL and MCL, it is a valuable addition to the pool of available treatments for these diseases.
Collapse
|
29
|
Ogura M, Uchida T, Taniwaki M, Ando K, Watanabe T, Kasai M, Matsumoto Y, Shimizu D, Ogawa Y, Ohmachi K, Yokoyama H, Tobinai K. Phase I and pharmacokinetic study of bendamustine hydrochloride in relapsed or refractory indolent B-cell non-Hodgkin lymphoma and mantle cell lymphoma. Cancer Sci 2010; 101:2054-8. [PMID: 20594195 PMCID: PMC11159326 DOI: 10.1111/j.1349-7006.2010.01633.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bendamustine is a cytotoxic agent with a novel mechanism of action. This phase I, dose-escalation study evaluated the safety, tolerability, efficacy, and pharmacokinetics of bendamustine in Japanese patients with relapsed/refractory indolent B-cell non-Hodgkin lymphoma (B-NHL) or mantle cell lymphoma (MCL) without major organ dysfunction. Bendamustine 90 or 120 mg/m(2) (dose escalation) was administered intravenously over 60 min on days 1 and 2 every 3 weeks for up to three cycles. Nine patients (eight indolent B-NHL and one MCL) received per-protocol treatment, three at 90 mg/m(2) and six at 120 mg/m(2) . No dose-limiting toxicities were observed; thus, the maximum-tolerated dose was not reached. Grade 3/4 hematologic toxicities were neutropenia (33%) and leukopenia (33%). Non-hematologic toxicities were grade 1/2 and included gastrointestinal events and fatigue. Peak plasma concentrations of bendamustine occurred near the end of infusion in both dose groups and were equivalent to therapeutic concentrations observed in vitro. Bendamustine was rapidly eliminated, with a mean elimination half-life (t(1/2) ) of 29 min. Plasma concentrations of active metabolites M3 and M4 were approximately 4 and <1% of the plasma concentration of the parent molecule, with t(1/2) of 42 and 33 min, respectively. Two unconfirmed complete responses and six partial responses were observed for an overall response rate (ORR) of 89%. The recommended dose for this schedule in phase II trials is 120 mg/m(2) . The acceptable safety profile and high ORR warrant further investigation of bendamustine in relapsed or refractory indolent B-NHL and MCL.
Collapse
Affiliation(s)
- Michinori Ogura
- Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Bendamustine: something old, something new. Cancer Chemother Pharmacol 2010; 66:413-23. [PMID: 20376452 DOI: 10.1007/s00280-010-1317-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 03/28/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bendamustine (Treanda, Ribomustin) is a water-soluble, bifunctional chemotherapeutic agent that also has potential antimetabolite properties and only partial cross-resistance with other alkylators. Designed in 1963 and re-discovered in 1990s, this drug's unique mechanism of action and favorable side-effect profile promise a major role in the management of lymphoproliferative disorders. Bendamustine has been designated as an orphan drug in the United States, conferring prolonged market exclusivity. OBJECTIVE This article provides a comprehensive review of the data on efficacy and toxicity from trials investigating the use of bendamustine for the treatment of lymphoproliferative neoplasms. The pharmacology, pharmacokinetics, and pre-clinical studies with bendamustine are also reviewed. METHODS MEDLINE and Pubmed databases (1970-2010) were searched using the terms bendamustine, bendamustin, Treanda, Ribomustin, SDX-105, IMET-3393, and Cytostasan. All relevant articles were reviewed and references screened for additional articles. The databases of the American Society of Hematology (2004-2009) and the American Society of Clinical Oncology (1995-2009) were also searched for relevant abstracts. RESULTS Bendamustine induces a remission in more than three-fourths of patients with rituximab-refractory indolent B cell non-Hodgkin lymphoma (NHL). Combined with rituximab in vitro, bendamustine shows synergistic effects against various leukemia and lymphoma cell lines. Clinical trials supporting these results show that bendamustine plus rituximab is highly effective in patients with relapsed-refractory indolent lymphoma, inducing remissions in 90% or more and a median progression-free survival of 23-24 months. Bendamustine has been reasonably well tolerated in clinical trials with low propensity to induce alopecia. CONCLUSIONS Combination of bendamustine and rituximab has the potential to become a new standard first-line treatment option for patients with FL, MCL, and indolent lymphomas. Results of ongoing trials will help to further elucidate the optimal role of bendamustine in indolent NHL.
Collapse
|
31
|
Dennie TW, Kolesar JM. Bendamustine for the treatment of chronic lymphocytic leukemia and rituximab-refractory, indolent B-cell non-Hodgkin lymphoma. Clin Ther 2010; 31 Pt 2:2290-311. [PMID: 20110042 DOI: 10.1016/j.clinthera.2009.11.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bendamustine is a mechlorethamine derivative with a purine-like benzimidazole ring, which may enhance its clinical efficacy. Bendamustine was approved by the US Food and Drug Administration (FDA) for the treatment of chronic lymphocytic leukemia (CLL) in March 2008 and for the treatment of rituximab-refractory, indolent B-cell non-Hodgkin lymphoma (NHL) in October 2008. OBJECTIVE This article reviews the pharmacologic and pharmacodynamic properties of bendamustine, together with data on efficacy and toxicity from trials investigating the use of bendamustine for the treatment of various hematologic malignancies, including CLL, NHL, and multiple myeloma (MM). METHODS MEDLINE and International Pharmaceutical Abstracts (1970-April 15, 2009) were searched using the terms bendamustine, bendamustin, Treanda, Ribomustin, SDX-105, IMET-3393, and Cytostasan. References from relevant articles were also reviewed for additional sources and material. The databases of the American Society of Hematology (2004-2008) and the American Society of Clinical Oncology (1995-2008) were searched for relevant abstracts. RESULTS Bendamustine is a mechlorethamine derivative with structural similarity to chlorambucil and other drugs from the nitrogen mustard class, as well as a benzimidazole ring, which may act as an antagonist to purines and amino acids. It has good oral bioavailability but has been studied almost exclusively in the intravenous formulation. It undergoes extensive first-pass metabolism by cytochrome P450 1A2 to active metabolites gamma-hydroxy bendamustine and N-desmethyl-bendamustine, but clinical activity appears to be associated primarily with the parent compound. The t(1/2) of bendamustine is approximately 40 minutes. While bendamustine has 2 moieties with possible antitumor effect, it is unclear to what extent the benzimidazole ring enhances the efficacy of the drug. Numerous studies including in vitro assays have reported, however, that bendamustine has little cross-resistance with other alkylating agents and remains active even in extensively pretreated patients. FDA approval for use in CLL was based on findings from a randomized, open-label, Phase III study comparing bendamustine with chlorambucil as single-agent therapy in treatmentnaive patients with CLL (Binet stage B or C). Bendamustine was administered intravenously at a dose of 100 mg/m2 on days 1 and 2, while chlorambucil was administered orally at 0.8 mg/kg daily, both over 4-week cycles for up to 6 cycles. At interim analysis (the data used for FDA approval), bendamustine was associated with a greater overall response (68% vs 39%; P < 0.001), median progression-free survival (21.7 vs 9.3 months; P < 0.001) and median duration of remission (18.9 vs 6.1 months; P < 0.001) compared with chlorambucil. FDA approval for rituximabrefractory, indolent B-cell NHL followed a Phase III, open-label, single-arm study evaluating bendamustine monotherapy in patients who did not respond to rituximab or had progressive disease within 6 months of rituximab therapy. Bendamustine 120 mg/m(2) was administered intravenously on days 1 and 2 of a 21-day cycle for up to 8 cycles. At interim analysis, the overall response rate was 84%, including 29% complete response. The median progression-free survival was 9.7 months. The efficacy of bendamustine has also been reported in the treatment of MM in clinical studies, and bendamustine has been approved in Europe for treating MM, NHL, CLL, breast cancer, and Hodgkin lymphoma. Dose-limiting toxicity is primarily hematologic. Treatment-associated infections have been reported in some studies; however, nonhematologic adverse events have rarely been dose limiting. The most common nonhematologic adverse events include fatigue, nausea, xerostomia, and pyrexia. CONCLUSIONS Bendamustine is a mechlorethamine derivative with a purine-like benzimidazole ring, which may enhance its clinical efficacy. It has been approved in the United States for the treatment of CLL and rituximab-refractory, indolent B-cell NHL. It has been approved in Europe for use in other malignancies, and clinical studies have reported activity in MM.
Collapse
Affiliation(s)
- Trevor W Dennie
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | | |
Collapse
|
32
|
Bendamustine pharmacokinetic profile and exposure-response relationships in patients with indolent non-Hodgkin's lymphoma. Cancer Chemother Pharmacol 2010; 66:1039-49. [PMID: 20140617 DOI: 10.1007/s00280-010-1254-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2009] [Accepted: 01/12/2010] [Indexed: 12/22/2022]
Abstract
PURPOSE The pharmacokinetic profiles of bendamustine and active metabolites were defined in patients with rituximab-refractory, relapsed indolent B-cell non-Hodgkin's lymphoma, and supported understanding of exposure-response relationships for efficacy and safety. METHODS Bendamustine was administered as a 60-min 120 mg/m(2) intravenous infusion on days 1 and 2 of six 21-day cycles. Pharmacokinetic models were developed, with covariate assessment. Correlations between bendamustine exposure and responder status or occurrence of neutropenia, thrombocytopenia, fatigue, nausea, and vomiting were examined. RESULTS Following a single dose of bendamustine HCl, concentrations declined in a triphasic manner, with rapid distribution, intermediate, and slow terminal phases. The intermediate t (1/2) (40 min) was considered the pharmacologically relevant (beta elimination) t (1/2) since the initial phases accounted for 99% of the AUC. Age, sex, mild/moderate renal, or mild liver impairment did not alter pharmacokinetics. Metabolite concentrations were low relative to parent. No correlation was observed between exposure and safety or efficacy measures because of the limited range of exposures after 120 mg/m(2) administration, except bendamustine C (max) was a significant (P value = 0.013) predictor of the probability of nausea in patients, most of whom were pretreated with antiemetics. CONCLUSIONS The BSA-based dosing regimen for bendamustine achieved the targeted exposure and was associated with a high incidence of therapeutic response. Given the short t (1/2) and low concentrations of bendamustine observed by 12 h after dosing, the single-dose profile for bendamustine described by these analyses is expected to be representative of the multiple-dose profile. The occurrence of nausea was significantly related to bendamustine exposure, with the probability of nausea increasing as bendamustine C (max) increases.
Collapse
|
33
|
Cheson BD, Wendtner CM, Pieper A, Dreyling M, Friedberg J, Hoelzer D, Moreau P, Gribben J, Knop S, Montillo M, Rummel M. Optimal Use of Bendamustine in Chronic Lymphocytic Leukemia, Non-Hodgkin Lymphomas, and Multiple Myeloma: Treatment Recommendations From an International Consensus Panel. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2010; 10:21-7. [DOI: 10.3816/clml.2010.n.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
34
|
Aldoss IT, Blumel SM, Bierman PJ. The role of bendamustine in the treatment of indolent non-Hodgkin lymphoma. Cancer Manag Res 2009; 1:155-65. [PMID: 21188134 PMCID: PMC3004665 DOI: 10.2147/cmr.s5299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Indexed: 11/26/2022] Open
Abstract
There is no consensus on recommendations for the treatment of relapsed and refractory indolent non-Hodgkin lymphoma (NHL). Bendamustine hydrochloride (bendamustine) has recently been approved for treatment of these patients. Bendamustine is a uniquely structured alkylating agent that lacks cross-resistance with other alkylators. This agent has a high degree of activity against a variety of tumor cell lines. Clinically, bendamustine has demonstrated activity against indolent NHL, chronic lymphocytic lymphoma, multiple myeloma and mantle cell lymphoma. Moreover, studies have validated its activity in patients with indolent NHL who are resistant to purine analogs and rituximab. The cytotoxic activity of bendamustine has been shown to be synergistic with rituximab in hematological malignancies. The incidence of alopecia is significantly less than with other alkylating agents. Myelosuppression is the major toxicity associated with bendamustine.
Collapse
Affiliation(s)
- Ibrahim T Aldoss
- Department of Internal Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Susan M Blumel
- Section of Hematology – Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Philip J Bierman
- Section of Hematology – Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
35
|
Abstract
Bendamustine is a cytotoxic agent that combines alkylating and antimetabolite effects. It has shown promising efficacy in a number of hematological cancers and, hence, is being investigated in patients with chronic lymphocytic leukemia (CLL), which is the most common form of adult leukemia in the Western world. Phase I/II trials with bendamustine as single-agent therapy in CLL have shown overall response rates of 56-93% and complete response rates of 7-29%. Preliminary data from a Phase III trial comparing bendamustine and chlorambucil (an agent widely used in the current treatment of CLL) have shown significantly higher response rates with bendamustine. Bendamustine has also shown activity in CLL when combined with mitoxantrone, rituximab or both. The principal toxicities associated with bendamustine are hematological, mainly leukopenia.
Collapse
|
36
|
Abstract
Bendamustine is a unique cytotoxic agent with structural similarities to alkylating agents and antimetabolites, but which is non–cross-resistant with alkylating agents and other drugs in vitro and in the clinic. Early clinical studies conducted in the German Democratic Republic more than 30 years ago suggested promising activity in indolent non-Hodgkin's lymphoma (NHL). Two North American trials reported responses in more than 70% of patients with chemotherapy- and rituximab-refractory disease, suggesting that bendamustine may be the most effective drug available for this patient population. Response rates of 90% to 92%, with complete remission in 55% to 60%, have been reported in patients with follicular and mantle-cell lymphoma with the combination of bendamustine and rituximab. Superiority over chlorambucil in previously untreated patients with chronic lymphocytic leukemia (CLL) led to its recent approval for this disease in the United States. Bendamustine is approved in Germany for the treatment of patients with indolent NHL, CLL, and multiple myeloma. Activity has also been noted in patients with breast cancer and small-cell lung cancer. Questions related to the optimization of bendamustine therapy, including dose and schedule, role relative to other available agents, and management of toxicities, are being investigated. However, the availability of bendamustine provides another effective treatment option for patients with lymphoid malignancies.
Collapse
Affiliation(s)
- Bruce D. Cheson
- From the Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; and Justus Liebig University Hospital, Department of Hematology, Giessen, Germany
| | - Mathias J. Rummel
- From the Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC; and Justus Liebig University Hospital, Department of Hematology, Giessen, Germany
| |
Collapse
|
37
|
Pencheva I, Bogomilova A, Koseva N, Obreshkova D, Troev K. HPLC study on the stability of bendamustine hydrochloride immobilized onto polyphosphoesters. J Pharm Biomed Anal 2008; 48:1143-50. [DOI: 10.1016/j.jpba.2008.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 08/15/2008] [Accepted: 09/01/2008] [Indexed: 11/16/2022]
|
38
|
Schmidt-Hieber M, Busse A, Reufi B, Knauf W, Thiel E, Blau IW. Bendamustine, but not fludarabine, exhibits a low stem cell toxicity in vitro. J Cancer Res Clin Oncol 2008; 135:227-34. [PMID: 18719942 DOI: 10.1007/s00432-008-0453-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE We investigated the in vitro toxicity of bendamustine and fludarabine to hematopoietic progenitors and stem cells from healthy donors. METHODS Clonogenic agar colony assays, non-clonogenic long-term liquid cultures (LTC) and apoptosis assays were used to assess the cytotoxicity of both the agents. RESULTS Total colony-forming units (CFU) were more sensitive to fludarabine than to bendamustine in agar colony assays (IC(50) 0.7 microM/L and 8.5 microM/L, respectively). Using the Bliss independence model and combining the two agents yielded additive inhibition of progenitors. Non-clonogenic assays, including LTC and an apoptosis assay detecting activated caspases showed that stem cells are characterized by low sensitivity to bendamustine. In contrast, fludarabine strongly inhibited the viability and growth of stem cells in LTC. CONCLUSIONS Our data show that bendamustine is characterized by lower in vitro toxicity to hematopoietic progenitors and stem cells than fludarabine and might thus be preferable in regimens prior to stem cells apheresis.
Collapse
Affiliation(s)
- M Schmidt-Hieber
- Medizinische Klinik III (Hämatologie, Onkologie und Transfusionsmedizin), Charité, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | | | | | | | | | | |
Collapse
|
39
|
|