"Use It Again!"

Retherapy With Bendamustine in Indolent B-Cell Lymphoproliferative Disorders

Marco Montillo; Alessandra Tedeschi

Disclosures

Expert Rev Hematol. 2013;6(3):247-250. 

In This Article

Summary of Methods & Results

In their article, Weide et al. reported data on efficacy and toxicity after retherapy with bendamustine in a population of patients with relapsed or refractory CLL and indolent B-cell malignancies.[16] Eighty eight patients (57 CLL and 31 NHL), who had been previously treated with bendamustine, were retreated with a bendamustine regimen. Different schedules of treatment were administered; bendamustine as monotherapy, BM, BR or bendamustine plus mitoxantrone and rituximab (BMR). Among these 88 patients, there were also patients who received multiple retreatment with bendamustine once relapsed after a retreatment with bendamustine. A major reason to perform this analysis was the fact that there are no data in the literature on retreatment with bendamustine-including regimens. All patients received prophylactic treatment with ciprofloxacin or levofloxacin, antiviral prophylaxis with acyclovir, antifungal prophylaxis with fluconazole and Pneumocystis jiroveci prophylaxis with thrimethoprim–sulfamethoxazole during the treatment phase until recovery of the hematologic parameters was seen. Granulocyte colony-stimulating factor was given at a dose of 300 µg prophylactically. Before bendamustine retherapy, patients had received a median of two pretherapy lines (range: 1–8). Eighty eight patients received a total of 164 bendamustine retherapies; the mean number of bendamustine retherapies per patient was 1.9 (range: 1–9). Completion of the planned treatment was approximately 60% in first, second, third and further retreatment. Hematological toxicity of grade 3 and 4 was the only toxicity of this degree observed in 35% of the courses administered.

ORR of all bendamustine retherapies was 76% with 7% for CR and 69% for partial remission. ORR in CLL was 77 (6%) and 71% (8% CR) in NHL. Twenty three patients received three or more bendamustine retherapies (26%), 16 patients received two bendamustine retherapies (18%) and 49 patients received only one bendamustine retherapy (56%). ORR was 80% after the first bendamustine retreatment (88 retherapies), 72% after the second (39 retherapies) and 70% after the third to the ninth (37 retherapies). Higher response rate in the NHL group was observed with BR compared with BM. Highest response rate in CLL was observed with BMR.

Median time to the next treatment between the first and the second bendamustine retherapy was 10 months (0–69 months). The median time to the next bendamustine therapy between second and third retreatment was 8 months (1–28 months). Overall median survival since first bendamustine-containing therapy was 33 months in the CLL group (2–129+ months) and 23 months in the NHL group (2–62+ months).

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