Bendamustine: a review of its use in the management of indolent non-Hodgkin lymphoma.

Bendamustine (Treanda, Ribomustin) is a bifunctional alkylating agent that also has potential antimetabolite properties, and only partial cross-resistance occurs between bendamustine and other alkylators. In patients with indolent non-Hodgkin lymphoma (NHL), bendamustine monotherapy achieved high objective response rates in those with rituximab-refractory disease in a pivotal noncomparative trial and a similarly designed smaller phase II study. Many of these heavily treated patients were also refractory to standard chemotherapy regimens. Several phase II trials demonstrated good response rates with single-agent bendamustine, or bendamustine in combination with rituximab, in patients with indolent NHL whose disease relapsed after (or was refractory to) chemotherapy. Phase III studies comparing combination regimens as first-line therapy in patients with indolent NHL showed no significant differences in response rates between bendamustine-containing regimens and standard regimens included in treatment guidelines. Bendamustine has been generally well tolerated in clinical trials and has a low propensity to induce alopecia. Results of ongoing trials will help to clarify the optimal role of bendamustine in indolent NHL. Available data indicate that it may be a particularly useful treatment option as monotherapy in patients with indolent NHL whose disease progressed during or following rituximab-based therapy, many of whom are also refractory to standard chemotherapy regimens.