Bendamustine (Intravenous)

Bendamustine injection is used to treat chronic lymphocytic leukemia and indolent B-cell non-Hodgkin's lymphoma in patients who have previously received

Overview

Bendamustine injection is used to treat long-term sufferers of lymphocytic leukemia (CLL white blood cell cancer) and indolent B-cell non-Hodgkin's lymphoma (NHL). The medication is used to treat patients who have previously received other treatments.

Bendamustine is one of a number of cancer medicines called alkylating agents. The drug works by interfering with the growth of cancerous cells, preventing them from attacking the body.

The medication is only given by or under the direct supervision of your doctor or oncologist. In the US, bendamustine is sold under the brand names Bendeka and Treanda and comes in solution or powder for solution form.

Conditions treated

  • Lymphocytic leukemia (CLL)
  • Indolent B-cell non-Hodgkin's lymphoma (NHL)

Type of medicine

  • Alkylating agent
  • Chemotherapy
  • Intravenous injection

Side-effects

Together with the benefits of receiving treatment with bendamustine, you may experience some unwanted or unpleasant side-effects. Many of these side-effects won't affect you, but you should speak to your specialist or to your doctor if they do, as you may require medical attention. If you experience any of the following side-effects after you begin taking bendamustine, you must consult your doctor or oncology specialist straight away.

  • vomiting
  • unusual bleeding or bruising
  • ulcers, sores, or white spots in your mouth, nose, or genitals
  • trouble breathing or swallowing
  • tightness in the chest
  • swollen glands
  • swelling of the feet or lower legs
  • sore throat, stuffy or runny nose
  • redness of the skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • pinpoint red spots on the skin
  • pale skin
  • painful or difficult urination
  • pain, tenderness, or swelling of the foot or leg
  • nausea
  • muscle aches
  • lower back, side, or stomach pain
  • loss of strength
  • joint pain, stiffness, or swelling
  • hives, itching, or rash
  • headache
  • feeling irritable
  • fast heartbeat
  • dizziness
  • diarrhea
  • cough or hoarseness
  • chills, fever
  • chest pain
  • changes in skin color
  • burning or stinging of the skin
  • breathing difficulties when under exertion
  • blood in the urine
  • bleeding gums
  • black, bloody, or tarry stools

This list of side-effects is not necessarily exhaustive. If you notice any other unusual effects, you should mention them to your treating physician straight away.

During your course of chemotherapy treatment, you could find that your hair may begin to thin. However, you should be reassured that you are unlikely to lose all of your hair. Hair thinning commonly starts after your first or second cycle of treatment with bendamustine. Any hair thinning that you experience is almost always temporary, and you should find that your hair will grow back normally when your course of treatment is completed. Your cancer nurse will discuss any concerns that you have and will advise you about any hair loss that you do experience. If you have long hair, a shorter, layered style can often help to disguise thinning.

Dosage

Medicines that are used to treat all forms of cancer are very strong and they can have many side-effects as mentioned above. Before you start a course of treatment with this medication, it is important that you fully understand that there are risks, as well as benefits. Be sure to work closely with your medical team during your treatment with bendamustine.

You will always receive this medication in a cancer treatment center or hospital. The drug will be given to you by a nurse or other trained member of medical staff. The medication is administered very slowly, via a needle placed into one of your veins. Before your treatment commences, you will be given anti-sickness drugs to prevent you from feeling nauseous during your treatment.

Your nurse will insert a short, thin tube (cannula) into a vein in your arm or hand. A further very fine tube will be placed under the skin of your chest and into a vein close by; this is called a central line. Finally, a fine tube will be inserted into your arm and fed up into a vein in your chest; this is called a PICC line. Your nurse will administer the bendamustine as an infusion (drip), into your cannula or line. They usually run the drip via a pump, which will administer the dosage steadily over a period of between 30 and 60 minutes.

Your treatment with bendamustine will be given to you over a course of several cycles or sessions. This treatment is usually given over the course of a few months. During this time, you will most likely be given an infusion of bendamustine for two days, every three to four weeks. Your chemotherapy treatment may be given alone or in combination with other chemotherapy drugs. The length of your course of treatment and the total number of treatment cycles that you will receive will depend on the form of cancer for which you are being treated. Your nurse or oncology specialist will discuss your treatment plan fully with you.

The dose of chemotherapy that you will receive will depend upon the medical condition for which you are receiving treatment. Your weight and your body's response to the treatment will also influence the dose you are given. Before each cycle of treatment, you will have blood tests to allow your medical team to work out the correct dose and frequency of dose that will be best for you.

Before you receive your treatment, your doctor may recommend that you take a fever-reducer, an antihistamine, and a corticosteroid such as dexamethasone. These medications will help to negate any side-effects that might be caused by bendamustine.

In the event that bendamustine leaks out of your vein into the surrounding tissue, it may cause serious tissue and skin damage. Tell your treating physician or nurse immediately if you begin to experience irritation, reddening of the skin, pain, or swelling at the injection site.

Major drug interactions

Some forms of medication must not be used together. However, in other cases, some drugs may be used concurrently, even though an interaction may occur. In this case, your doctor may elect to change the dose of one of your medications or alternatively may suggest precautions that you can take.

You should not receive bendamustine if you are intending to receive any of the following vaccinations. It is better to wait until the conclusion of your course of bendamustine before receiving these drugs. However, your doctor will advise you on the best course of action if you are concerned that you might contract one of these diseases if you are not vaccinated.

Bendamustine is not usually recommended for use with the following medications, although it may be necessary in some cases. If both these drugs are prescribed for use together, your doctor may change your dose or the frequency of use of one or both of the medicines:

  • adenovirus vaccine
  • Bacillus of Calmette and Guerin live Vaccine
  • cholera live vaccine
  • Ciprofloxacin
  • Fluvoxamine
  • influenza virus live vaccine
  • Omeprazole
  • poliovirus live vaccine
  • smallpox vaccine
  • typhoid vaccine
  • yellow fever vaccine

It is important to note here that you must not use tobacco while you are taking bendamustine. Your doctor will advise you when it is safe for you to resume smoking.

Warnings

During the course of your treatment with this medication, you will be required to attend your doctor regularly for check-ups to make sure that the medication is working correctly. You may have blood tests to check for any side-effects that the drug is causing.

Bendamustine can harm your unborn baby. Do not get pregnant while you are receiving this treatment and for at least three months after your course of this drug has been completed. If you think you may be pregnant while you are using this medication, tell your doctor immediately. Ask your doctor for advice on effective forms of birth control that you can use during the course of your treatment with bendamustine.

It is not known whether this drug passes into breast milk. However, if you are breastfeeding, you should discuss with your doctor whether it is worth the potential risk to your nursing infant of continuing to breastfeed while you are on this drug therapy. Your midwife will advise you on alternative nutrition for your baby.

Bendamustine can lower the number of white blood cells contained within your blood. This can increase your chances of contracting an infection, for example, pneumonia. The volume of platelets in your blood could also be lowered, preventing effective blood clotting. There are a number of precautions that you can take, especially when your blood count is low.

  • Try to avoid environments where you may contract an infection, such as crowded areas. If you develop a fever, chills, a cough, pain in your side or lower back, pain when urinating, unusual bleeding or bruising, or shortness of breath, consult your doctor without delay.
  • Check with your doctor if you experience any unusual bleeding or bruising, tarry or black stools, blood in your stools or urine, or tiny red dots on your skin.
  • Use a soft toothbrush, and avoid vigorous flossing or using a toothpick. Consult your doctor before undergoing dental treatment.
  • Keep your fingers away from your eyes and nose, unless you have just washed your hands.
  • Take extra care when using sharp implements such as safety razors or nail clippers.

Bendamustine can cause serious allergic reactions, including anaphylaxis. Anaphylaxis is life-threatening and always justifies emergency medical attention. If you begin to experience chills, fever, hoarseness, itching, hives, a rash, breathing or swallowing problems, or any swelling on your face, mouth or hands immediately after receiving this medication, tell your treating physician immediately.

Bendamustine can cause tumor lysis syndrome. Tell your doctor if you notice a decrease in your urine output, joint pain, pain in your back, side or stomach, rapid weight gain, swelling of the extremities, or muscular stiffness.

This drug sometimes causes necrosis under the skin at the injection site. If you notice indented skin, skin discoloration to blue-black, peeling skin, or reddening of the skin, tell your doctor right away.

This drug could make you feel very tired or weak. Until you know how this drug will affect you, avoid driving or operating dangerous machinery.

This medication can decrease the production of sperm in men and can therefore lower male fertility. If you have sex within the first couple of days of receiving your chemotherapy treatment, you should use a condom. This is to shield your partner from any chemotherapy that may be present in semen or vaginal fluid.

Chemotherapy treatment can sometimes affect the ovaries so that you do not have a period each month. You periods may eventually stop altogether. This is often just temporary and periods will resume once your chemotherapy has finished. Women who are approaching the menopause, may find that their periods stop permanently.

Some existing medical conditions can affect the efficacy of this medication. Tell your doctor if you have a history of:

Storage

This medication should be stored at room temperature. The medication is not suitable for freezing, nor should it be exposed to direct sunlight or to sources of extreme heat.

You should not store this medication in your bathroom.

Summary

Bendamustine injection is used in the treatment of sufferers of chronic lymphocytic leukemia (CLL white blood cell cancer) and indolent B-cell non-Hodgkin's lymphoma (NHL). The medication is used to treat patients who have previously received other treatments. The drug works by interfering with the growth of cancerous cells, preventing them from spreading and affecting the body. The drug is only administered by a medical professional in a hospital or cancer clinic environment.

Bendamustine is very potent and can cause serious side-effects, including localised necrosis at the injection site, liver, and kidney problems. There are also a number of commonly prescribed live and dormant vaccines that cannot be used with bendamustine, because of the side-effects caused by the interaction. For this reason you must be sure to discuss your full medical history with your doctor, and remember to mention the drugs that you are taking to treat them. Note that you must not smoke while being treated with this drug.

Bendamustine is very effective in slowing the spread of chronic lymphocytic leukemia (CLL white blood cell cancer) and indolent B-cell non-Hodgkin's lymphoma (NHL). To achieve the best results and to enjoy the full benefits of this medication, you must work closely with your doctor in order to find the appropriate dose and frequency of use for this drug therapy. This will include attending for regular check-ups and blood tests to make sure that the drug is working effectively and that there are no unwanted side-effects.

Resources
Last Reviewed:
December 25, 2017
Last Updated:
April 04, 2018