TY - JOUR
T1 - Bendamustine hydrochloride in patients with B-cell malignancies who have comorbidities–is there an optimal dose?
AU - Gordon, Max J.
AU - Lewis, Lionel D.
AU - Brown, Jennifer R.
AU - Danilov, Alexey V.
N1 - Publisher Copyright:
© 2017 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2017/8/3
Y1 - 2017/8/3
N2 - 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.
AB - 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.
KW - Chronic lymphocytic leukemia (CLL)
KW - cumulative illness risk scale (CIRS)
KW - dose reduction
KW - non-Hodgkin lymphoma (NHL)
KW - renal insufficiency
KW - therapy
UR - http://www.scopus.com/inward/record.url?scp=85026438242&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85026438242&partnerID=8YFLogxK
U2 - 10.1080/17474086.2017.1350166
DO - 10.1080/17474086.2017.1350166
M3 - Review article
C2 - 28664772
AN - SCOPUS:85026438242
SN - 1747-4086
VL - 10
SP - 707
EP - 718
JO - Expert Review of Hematology
JF - Expert Review of Hematology
IS - 8
ER -