Indication:
- Indolent B-cell NHL (e.g., follicular lymphoma), mantle cell lymphoma
- Often used in frontline or relapsed settings
Agents:
- Bendamustine: Alkylating agent with purine analog activity
- Rituximab: Anti-CD20 monoclonal antibody
Dosing (Typical Schedule):
Cycle = 28 days; typically 6 cycles
- Bendamustine: 90 mg/m² IV Days 1 and 2
- Rituximab: 375 mg/m² IV Day 1 (can be moved to Day 0 to reduce infusion overlap with bendamustine)
Key Pharmacist Considerations:
Pre-medications:
- Rituximab: Acetaminophen, antihistamine, corticosteroid to reduce infusion reactions
- Antiemetics for bendamustine (moderate emetogenic risk)
Infusion Reactions:
- Rituximab: Monitor closely during 1st infusion; slower rate and premeds required
- Common (especially neutropenia); monitor CBC regularly
- Consider growth factor support depending on patient risk
Infection Risk:
- Risk of reactivation (HBV, PJP, VZV); screen for HBV before starting
- Consider prophylaxis (e.g., antivirals, PJP prophylaxis based on risk)
Other Toxicities:
- Bendamustine: Rash, fatigue, electrolyte disturbances
- Tumor lysis syndrome (TLS) risk in bulky disease—ensure hydration, monitor labs
Renal/Hepatic:
- Adjust bendamustine in renal impairment; caution in hepatic dysfunction