In slow-growing lymphomas (such as follicular lymphoma) and mantle cell lymphoma that need treatment, this study compared two regimens: bendamustine with rituximab versus the older R-CHOP regimen. With bendamustine-rituximab, the disease took much longer on average to grow again (about 69 months versus 31 months), and side effects such as hair loss, low blood counts, infections and numbness in the hands and feet were less common; skin reactions, however, were a little more frequent. Your doctor will choose the best regimen based on the type of lymphoma and your situation.
Follicular lymphoma or other indolent lymphomas and mantle cell lymphoma requiring treatment, first line
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Bendamustine | 90 mg/m² | IV | Days 1 and 2 |
| Rituximab | 375 mg/m² | IV | Day 1 |
Doses from the StiL NHL1 trial. Do not use bendamustine with creatinine clearance below 30 mL/min; the 120 mg/m² dose on the FDA label refers to monotherapy for rituximab-refractory indolent lymphoma, not to the BR regimen.
On the page “Lymphoma” · Treatment regimens and dosing: follicular lymphoma
Previously untreated mantle cell lymphoma in patients aged 65 years and older
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Ibrutinib | 560 mg once daily | Oral | Continuous |
| Bendamustine | 90 mg/m² | IV | Days 1 and 2, every 28 days (6 cycles) |
| Rituximab | 375 mg/m² | IV | Every 28 days (6 cycles) |
| Maintenance (complete or partial response) | |||
| Rituximab | 375 mg/m² | IV | Every 8 weeks for up to 12 doses |
Doses from the SHINE abstract; the BR schedule (Days 1 and 2 every 28 days) follows the standard regimen.
On the page “Lymphoma” · Treatment regimens and dosing: mantle cell lymphoma
Follicular, marginal zone, mantle cell lymphoma, Waldenström
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Bendamustine | 90 mg/m² | IV | Days 1 and 2 |
| Rituximab | 375 mg/m² | IV | Day 1 |
As in StiL NHL1.
Dose source:.
By disease
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| CLL | |||
| Bendamustine | 100 mg/m² | IV over 10 minutes (Bendeka) | Days 1 and 2 every 28 days, up to 6 cycles |
| Rituximab-refractory lymphoma | |||
| Bendamustine | 120 mg/m² | IV | Days 1 and 2 every 21 days, up to 8 cycles |
| With rituximab (BR) | |||
| Bendamustine | 90 mg/m² | IV | Days 1 and 2 every 28 days |
Single-agent doses as per the label; BR as in StiL NHL1 (the BR regimen).
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Bendamustine IV 90 mg/m² on days 1 and 2 of each 4-week cycle, plus rituximab 375 mg/m² on day 1 of each cycle; up to six cycles.
Cycles every 3 weeks: cyclophosphamide 750 mg/m², doxorubicin 50 mg/m² and vincristine 1.4 mg/m² on day 1, and prednisone 100 mg/day for 5 days, plus rituximab 375 mg/m² on day 1 of each cycle; up to six cycles.
Source of the regimen details: Abstract of the paper in PubMed
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Patients aged 18 years or older with WHO performance status of 2 or less and newly diagnosed stage 3 or 4 indolent lymphoma or mantle cell lymphoma.
Primary outcome: progression-free survival, with a non-inferiority margin of 10%; per-protocol analysis.
Bendamustine-rituximab was better tolerated than R-CHOP: alopecia 0 patients versus 245 (100%) of 245 patients who received 3 or more cycles; haematological toxicity 30% versus 68%; infections 37% versus 50%; peripheral neuropathy 7% versus 29%; stomatitis 6% versus 19%. Erythematous skin reactions were more common with bendamustine-rituximab (16% versus 9%; p=0.024).
Based on this trial, the authors considered bendamustine-rituximab the preferred first-line approach over R-CHOP in untreated indolent lymphoma, because of longer progression-free survival and fewer adverse events. This study is one of the main pieces of evidence for bendamustine-rituximab as a first-line option in advanced indolent lymphomas and in mantle cell lymphoma in older patients.
Open-label design (patients and physicians knew the treatment); per-protocol rather than intention-to-treat analysis; all centres were in Germany; patients with different histological subtypes (indolent and mantle cell) were enrolled. The abstract reports no overall survival data.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.
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