Class: Alkylating agent (Nitrogen mustard derivative) with purine-like properties.
- Structure: Contains a nitrogen mustard group (alkylator) and a benzimidazole ring (purine analog feature) → gives it dual mechanism.
Mechanism of Action
- Alkylates DNA → intra- and inter-strand cross-links → inhibits DNA replication and transcription.
- Purine analog–like activity → interferes with DNA synthesis and repair.
- Leads to apoptosis and mitotic catastrophe.
Clinical Uses
- Chronic lymphocytic leukemia (CLL).
- Indolent non-Hodgkin’s lymphomas (NHL), including rituximab-refractory disease.
- Off-label: mantle cell lymphoma, multiple myeloma, HL.
Dosing
- IV:
- CLL: 100 mg/m² IV on days 1 and 2 of a 28-day cycle × 6 cycles.
- NHL: 120 mg/m² IV on days 1 and 2 of a 21-day cycle × 6–8 cycles.
- Premedicate with antiemetics; hydration recommended.
Toxicities
- Myelosuppression (dose-limiting; neutropenia, thrombocytopenia, anemia).
- Infections (opportunistic, reactivation of hepatitis B, CMV, PCP).
- Infusion-related reactions.
- Nausea, vomiting, fatigue, fever.
- Dermatologic: rash, rare Stevens–Johnson syndrome (SJS)/TEN.
- Secondary malignancies (MDS, AML with prolonged use).
Monitoring
- CBC before and during cycles.
- Hepatitis B screening (risk of reactivation).
- Monitor for opportunistic infections (consider prophylaxis).
- Renal and hepatic function tests.
- Watch for infusion-related reactions and skin toxicity.
In summary:
Bendamustine is a hybrid alkylator with purine-like activity, widely used in CLL and indolent NHL. Its hallmark is myelosuppression and immunosuppression, with risk of infections and secondary malignancies, making infection prophylaxis and monitoring critical.
Synonyms
Treanda, Belrapzo