Expert Commentary & Five-year View
The available data collected in the last few years suggest that bendamustine is a reasonable treatment option for patients with relapsed or refractory low-grade NHL and for patients with CLL. The results reported by Weide et al. are quite interesting because generally there are no data available in the literature showing the impact of a retreatment with the same schedule or with a schedule including the same chemotherapeutic agent. However, retreatment with the previous therapy is not recommended in patients whose initial treatment was suboptimal in terms of quality of response and duration, so we imagine that the authors retreated, with a regimen including bendamustine, only patients who showed a long-lasting response to the previous line including this particular alkylator. This fact may represent a bias because the percentage of patients whose relapse was retreated with a regimen including bendamustine from the total number of patients initially treated with this drug was not reported. Nevertheless, their experience with bendamustine is unique and gives us some important information that was otherwise impossible to know.
Clinicians have a variety of treatment options for patients with CLL and indolent NHL who have relapsed and the reason to administer the same drug again in monotherapy or in combination comes from the experience of manageability and efficacy of the reused drug.
Indeed, a percentage of more than 70% of the responses, often of long duration, after the third retreatment should be considered a good performance, giving a relatively little amount of toxicity. In the present series, the results of BR efficacy are confirmed in both CLL and NHL settings while the addition of mitoxantrone, despite the positive single center experience reported, should be tested in a Phase III trial. The challenge for the next few years will be the incorporation of a number of new targeted agents (e.g., BCL2 agonist and BCR inhibitor) in schedules including bendamustine.
Finally, some questions still remain to be answered, such as the effect of bendamustine on hematopoietic stem cells and the subsequent ability of harvesting after treatment. Similarly, there are only few data regarding the potential effect of bendamustine on the development of secondary myelodysplastic syndromes. These issues were not expanded in this article and could be investigated in future studies.
Expert Rev Hematol. 2013;6(3):247-250. © 2013 Expert Reviews Ltd.