Regimen R-Bendamustine

Please note there are several protocols with similar dosing and indications. Check you are
following the correct protocol before proceeding

Indication Low grade and indolent lymphomas

Therapeutic Intent Disease modification

Day Medication Dose Route Administration Details

Give in 500ml Sodium Chloride 0.9% over
1 and 2 Bendamustine 90mg/m2 IV
30-60 minutes.
Add to sodium chloride 0.9%. See local
1 Rituximab 375mg/m2 IV protocol or product SPC for information of
rate of infusion.

**Irradiated blood products recommended until further information available**

Cycle Frequency Every 28 days to a maximum of 6 cycles.

Tests required prior to
initiation of course
Tests required prior to
individual cycle
Concurrent Medication
FBC, U&E, LFT, Bone profile, glucose, LDH, B2M, serum Igs, electrophoresis,
hep B screen.
Undertake relevant staging.
WHO performance status.
FBC, U&E, LFT.
N.B. If serum K <3.5, supplement and perform ECG prior to treatment.
Antihistamine, corticosteroid and paracetamol pre-medication prior to
rituximab as per local policy.
Allopurinol for the first three cycles only.
Anti-emetics as per local policy.
Consider antifungal, antiviral (aciclovir may interact with bendamustine),
PCP prophylaxis and mouthwashes as per local policy.

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Dose Modifications
Serum Bilirubin (micromol/L) Modification
<20 None
Hepatic
20-50 Reduce dose by 30%
>50 No data available
On the basis of pharmacokinetic data, no dose adjustment is necessary in patients with
Renal a creatinine clearance of > 10 ml/min. Experience in patients with severe renal
impairment is limited, monitor carefully for myelosuppression.
No dose modifications for first cycle. Bendamustine administration should be delayed
by one week in the event of grade 3 of greater haematological toxicity. Once blood
counts have improved (Absolute neutrophil count (ANC) ≥ 1x109/L and platelets ≥
75x109/L) bendamustine can be initiated with the following dose modifications.
Haematological Parameter Modification
First episode of grade 3 or greater Give bendamustine 50mg/m2 on days 1 and 2 of
toxicity each cycle
Subsequent episodes of grade 3 of Give bendamustine 25mg/m2 on days 1 and 2 of
greater toxicity each cycle
Bendamustine administration should be delayed by one week in the event of clinically
Other non-
significant grade ≥2 non-haematological toxicity on day treatment due. Once non-
haematological
haematological toxicity has recovered to ≤ grade 1 bendamustine can be reinitiated at
toxicity
50mg/m2. Dose re-escalation in subsequent cycles may be considered

Additional Information None.

1. Rummel MJ et al: Bendamustine plus Rituximab versus R-CHOP in first

line treatment of patients with indolent and Mantle Cell Lymphomas: an
open label, multicentre, randomised, phase III non-inferiority trial.
Lancet 2013 Apr 6;381(9873):1184
References
2. Guidelines on the use of irradiated blood components prepared by the
BCSH blood transfusion task force. British Journal of Haematology 2011;
152:35-51
3. SPCs for Rituximab/ Bendamustine available at www.medicines.org.uk

Author Pharmacy CNG

Approved & Checked by Haematology CNG (Review Date = Jan 2017)

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