Toxicity
The 2013 study by Rummel et al. reported BR to be better tolerated than R-CHOP (see tables below). There were lower rates of alopecia (0% vs 100%; p<0.0001), haematological toxicity (30% vs 68%; p<0.0001), infections (37% vs 50%; p=0.0025), peripheral neuropathy (7% vs 29%; p<0.0001) and stomatitis (6% vs 19%; p<0.0001). BR was associated with more erythematous skin reactions (16% vs 23% p=0.024).r
Table 1: Haematological toxic events in patients receiving at least one dose of study treatmentr
© The Lancet 2013
Table 2: All grades of non-haematological toxic events in patients receiving at least one dose of study treatmentr
© The Lancet 2013
Analysis of the 2017 study by Marcus et al. with chemotherapy backbone showed more serious adverse events (AE’s) prior to the next line of treatment in the BR (47%) group than the R-CHOP (33%) and RCVP (34%) groups.rrr Frequency of grade 3-5 AE’s were higher in the R-CHOP group - due to increased cytopenias, however group 3-5 infection were higher in the BR group due to infections in the maintenance phase. Fatal AE’s were higher with BR (4%) than R-CHOP (2%) or R-CVP (2%) and more common in patients age >70.
Table 3: Adverse events and serious adverse eventsr
© N Engl J Med 2017
A long term follow up study of 149 patients with relapsed NHL treated in three different clinical trials with bendamustine demonstrated an annual incidence rate of MDS/AML of 0.5%/person/year. The median time to development of MDS/AML after bendamustine was 23 months. Twelve patients had stem cell collection attempted following bendamustine, 9 of whom were collected successfully. The most common infections after bendamustine were sinopulmonary, followed by HSV/VZV, sepsis and urinary tract infection.r