Bendamustine in the Treatment of Low-Grade Non-Hodgkin’s Lymphomas

Bendamustine is a nitrogen mustard derivative, devel-oped in East Germany in the early 60s in search for new cytotoxic drugs belonging to the group of alkylating drugs. With regard to its structure, an action as a purine analogue must be assumed, too. Bendamustine induces long-lasting DNA strand breaks and apoptosis. So far, bendamustine did not show cross resistance with various other chemotherapeutics including alkylating agents as chlorambucil or cyclophosphamide. Recent clinical studies revealed major activity of bendamustine in low-grade non-Hodgkin’s lymphomas (NHL), chronic lymphocytic leukemias (CLL), and multiple myelomas (MM). The response rate (RR) varied between 59 and 97% in relapsed or refractory low-grade NHL, 69–94% in CLL, and 52–75% in MM. Therefore, bendamustine seems to be one of the most active single agents in low-grade NHLs comparable to the activity of purine analogues. The experience of combination of bendamustine with other cytostatics, however, is still rare. The toxicity profile of bendamustine showed only a low emetogenicity, no induction of alopecia and a myelosuppression comparable to that of other alkylating agents. The present data suggest bendamustine as a highly effective drug in refractory or relapsing low-grade NHL including CLL and MM. Its relevance in the second- and third-line therapy as well as in first-line schedules as a single agent and in combinations will have to be elucidated by further studies.