Bendamustine: a review of its use in the management of indolent non-Hodgkin's lymphoma and mantle cell lymphoma.

Bendamustine (bendamustine hydrochloride) is an alkylating agent indicated in several countries for the treatment of indolent non-Hodgkin's lymphoma (NHL) and mantle cell lymphoma (MCL). While the precise mechanism of action of bendamustine is as yet unknown, it has limited cross resistance to other alkylating agents and appears to exert its antineoplastic effects via a different mechanism to that of other alkylating agents. Bendamustine monotherapy was effective in treatment-refractory (including rituximab-refractory) indolent NHL or MCL. Moreover, bendamustine-based combination treatment was at least as effective as cyclophosphamide-based treatment, and bendamustine plus rituximab was at least as effective as cyclophosphamide, doxorubicin, vincristine plus prednisone (CHOP) plus rituximab, as first-line therapy in patients with indolent NHL or MCL. Treatment-refractory disease also appeared to respond favourably to bendamustine-containing combination treatment. In general, bendamustine was associated with a high overall response rate and a durable response. The most common adverse events associated with bendamustine were haematological or gastrointestinal in nature, and most were of mild to moderate severity. Regimens that included bendamustine were also associated with a very low rate of alopecia compared with regimens that included other antineoplastic drugs. In conclusion, bendamustine is a unique alkylating agent, which in clinical trials has demonstrated consistent efficacy and acceptable tolerability in patients with indolent NHL or MCL. It may be a particularly useful treatment option in patients with rituximab-refractory disease, but has also demonstrated efficacy as part of a first-line combination treatment. While further research is necessary to firmly establish the best place for bendamustine in the management of indolent NHL and MCL, it is a valuable addition to the pool of available treatments for these diseases.