+ -Text Size

Bendamustine

(ben-dah-muss-teen)

Trade/other name(s): Treanda® (tree-an-duh), bendamustine hydrochloride, SDX-105

Why would this drug be used?

Bendamustine is used to treat chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma. It may be used for other types of cancer.

How does this drug work?

Bendamustine is a type of chemotherapy drug that is thought to work in 2 ways. It acts as an alkylating agent that can damage DNA to keep cancer cells from growing. It also acts as an antimetabolite, a type of drug that interferes with making new DNA. This affects fast-growing cells such as cancer cells.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any type of kidney disease or liver disease (including hepatitis). Reduced kidney or liver function might result in more drug than expected staying in the body, which could lead to unwanted side effects. If you have liver or kidney problems, your doctor may need to monitor you more closely. This drug is not recommended for people with severe liver or kidney disease.
  • If you have any other medical conditions such as heart disease, congestive heart failure, diabetes, gout, or infections.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at conception or during pregnancy. You should use some kind of birth control during treatment and for at least 3 months afterward. Check with your doctor about what birth control can be used with this medicine.
  • If you are breastfeeding. It’s not known whether this drug passes into breast milk. If it does, it could harm the baby. Breastfeeding is not recommended during treatment with this drug.
  • If you think you might want to have children in the future. This drug can affect fertility. Talk with your doctor about the possible risk with this drug and the options that could preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. Keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency could help prevent complications if you get sick.

Interactions with other drugs

Several drugs may change the levels of bendamustine in the body by affecting how the drug is broken down. Your doctor may watch you more closely for side effects or change your dose of bendamustine. Some drugs that may affect bendamustine levels include:

  • Fluvoxamine (Luvox),
  • Stomach acid blockers cimetidine (Tagamet) and omeprazole (Prilosec)
  • Antibiotics such as ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin)
  • The blood thinner ticlopidine (Ticlid)
  • Tobacco smoke (cigarettes, pipes, cigars)

Other drugs may have this effect as well, which is why it’s very important that your doctor is aware of all drugs and supplements you take.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with bendamustine. These include:

  • Vitamin E
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • Warfarin (Coumadin)
  • Ticlopidine (Ticlid)
  • Clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren’t sure what’s in the medicines you take.

There may be an increased risk of severe skin problems, like blistering and peeling, when bendamustine and certain other drugs linked to skin problems, like allopurinol or rituximab, are given together. Cases of severe and even fatal skin reactions have been reported when allopurinol was given at the same time. (Allopurinol is a drug that is commonly used to treat gout. It’s also sometimes used at the start of cancer treatment to help prevent problems caused by many cancer cells dying at once. This is called tumor lysis syndrome and is discussed under “Precautions”.)

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Bendamustine is given as an infusion into a vein (intravenously, or IV) over 30 minutes, for 2 days in a row. This is done every 3 or 4 weeks, depending on the reason you are taking it. The dose depends on your body size. Doses may need to be delayed or adjusted if you have serious side effects from this drug.

You may be given another drug called allopurinol before and during treatment to help prevent a severe side effect known as tumor lysis syndrome (see “Precautions”). Allopurinol may be given IV or taken as a pill. Note: Allopurinol and other drugs known to cause skin reactions have been linked to severe skin reactions when given with bendamustine. Be sure to talk to your doctor about this risk.

Precautions

This drug can cause allergic reactions in some people while the drug is given, especially with the second or later cycles of treatment. Mild reactions may consist of fever, chills, skin itching, rash, or feeling flushed. More serious reactions happen rarely, but can be dangerous. Symptoms can include feeling lightheaded or dizzy (due to low blood pressure), chest tightness, shortness of breath, back pain, tightness in the throat, itching, hives, or swelling of the face, tongue, or eyes. Tell your doctor or nurse right away if you notice any of these symptoms during or after being given the drug.

Bendamustine can cause the rapid killing of tumor cells within the first 24 hours of treatment, causing their contents to spill into the blood. In some cases this can lead to serious kidney damage (a condition known as tumor lysis syndrome). This is more likely if you have a very large number of cancer cells in the body. If your doctor feels you might be at risk, he or she may give you certain medicines and/or fluids to help prevent this. Using these some of these medicines may increase the risk of severe skin reactions, so talk to your doctor about this possibility. If you notice pain in the back or sides of your chest or blood in your urine, tell your doctor right away (these are symptoms of tumor lysis).

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Be sure to keep all appointments for lab work and doctor visits.

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° F or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your red blood cell count. If this occurs, it’s usually a few weeks after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

This drug may lower your platelet count in the weeks after it’s given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body’s ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Do not get any immunizations (vaccines), either during or after treatment with this drug, without your doctor’s OK. Bendamustine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get live virus vaccines during treatment or for some time afterward. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

This drug can cause skin reactions, which may range from mild rashes to more severe skin problems, such as blistering and peeling. The risk of this is higher if certain other drugs, such as rituximab or allopurinol, are given along with bendamustine. Tell your doctor right away if you start to get a rash while taking this drug. More serious reactions may require that this drug be stopped.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Low white blood cell count with increased risk of infection*
  • Low platelet count with increased risk of bleeding*
  • Low red blood cell count (anemia), with tiredness, weakness, other symptoms*
  • Fever
  • Nausea
  • Vomiting
  • Diarrhea
  • Feeling tired
  • Loss of appetite
  • Abnormal blood test results that suggest the drug is affecting the liver or kidneys (Your doctor will discuss the importance of these findings, if any.)

Less common

  • Skin rash*
  • Trouble breathing or shortness of breath
  • Constipation
  • Feeling weak
  • Weight loss
  • Dry mouth
  • Cough
  • Headache
  • Mouth sores
  • Pain in chest, back, belly, bones, or joints
  • Infections in the lungs (pneumonia), sinuses, bladder, kidney

Rare

  • Tumor lysis syndrome with risk of kidney damage*
  • Allergic reactions*
  • Increased or decreased blood pressure
  • Death due to tumor lysis syndrome, severe skin reactions, bleeding, infection, and other causes

*See “Precautions” section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2008.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.

Last Medical Review: 05/15/2014
Last Revised: 05/16/2014