Bendamax

Indications

Bendamustine is a cancer medicine used to treat certain blood cancers, mainly chronic lymphocytic leukaemia (CLL) and indolent (slow-growing) non-Hodgkin lymphoma, including cases that have come back after other treatment. It is sometimes used together with Rituximab. It is also used in some cases of multiple myeloma.

How It Works

Bendamustine belongs to a group called alkylating agents. It attaches to the DNA inside cancer cells and links the DNA strands together, so the cells cannot copy themselves and eventually die. Because it also affects healthy fast-dividing cells, such as those in the bone marrow, it can lower blood counts.

Dosage and Administration

Bendamustine is given as an infusion into a vein by a doctor or nurse in a hospital or cancer centre. The dose is worked out by the cancer specialist from your body surface area, the type of cancer and your blood tests, and it is usually given on two days of a repeating cycle. Take it exactly as prescribed. Blood tests are done before each cycle, and the dose may be delayed or reduced if your blood counts are low.

Interactions

• Medicines that affect the liver enzyme CYP1A2, such as Ciprofloxacin, Fluvoxamine (raise levels) or smoking (may lower levels).
• Other medicines that suppress the bone marrow or the immune system can add to the risk of infection.
• Live vaccines should be avoided during and for some time after treatment.
• Allopurinol, used to prevent tumour lysis, has been linked to severe skin reactions when combined with Bendamustine.

Tell your doctor about every medicine, herbal product and supplement you use.

Contraindications

• Allergy to Bendamustine or Mannitol.
• Breastfeeding.
• Severe liver problems or jaundice.
• Very low blood counts before treatment, serious active infection, or major surgery within the previous month.

Side Effects

Common side effects include low white cells, red cells and platelets, infections, tiredness, fever, nausea, vomiting, loss of appetite, diarrhoea or constipation, headache, rash and mouth sores. Infusion reactions (chills, itching, rash during or soon after the drip) can occur. Less common but serious effects include severe skin reactions, tumour lysis syndrome (a chemical imbalance when many cancer cells break down quickly), reactivation of hepatitis B or other infections, heart rhythm problems and second cancers.

Get urgent medical help if you have a fever of 38°C or higher, chills, unusual bleeding or bruising, a widespread rash with blistering or peeling skin, breathing difficulty, chest pain, very little urine or yellowing of the skin or eyes.

Pregnancy and Lactation

Bendamustine can harm an unborn baby. Women and men should use reliable contraception during treatment and for several months afterwards, as advised by the doctor. Do not breastfeed during treatment. It may also affect fertility, so discuss this before starting.

Precautions and Warnings

• Regular blood tests and checks of liver and kidney function are needed.
• Report any sign of infection promptly; your doctor may give medicines to prevent certain infections.
• Drink plenty of fluids to help prevent tumour lysis syndrome.
• Protect skin from strong sunlight and report any new skin changes.
• Tell your doctor if you have heart disease or a history of hepatitis B.

Overdose

An overdose is unlikely because it is given by health professionals. Too much can cause severe bone marrow suppression and heart rhythm changes. There is no specific antidote; treatment is supportive with blood counts and heart monitoring in hospital.

Therapeutic Class

Antineoplastic (anticancer) agent, alkylating agent (nitrogen mustard derivative).

Storage

Hospital medicine: store as directed on the pack, usually below 25°C in the original carton to protect from light. Prepared infusions are handled by trained staff.