The second in a series of 4 articles describes the natural history of chronic lymphocytic leukemia (CLL) and indolent non-Hodgkin lymphoma (NHL). As 2 indolent lymphocytic malignancies, they have a similar natural history of a slowly progressive illness that can have progressive cytopenias and/or lymphadenopathy that eventually may require therapy. The initial therapies that have been used to treat CLL and indolent NHL have mostly included the use of alkylating agents or purine analogs in conjunction with rituximab. Although these agents have a high response rate, side effects can include myelosuppression and infectious complications. This article outlines the information for the use of bendamustine in patients with CLL or indolent NHL.
Bendamustine has been compared with chlorambucil for treatment of CLL that demonstrated a higher overall response rate (ORR) of 59% compared with 26% for chlorambucil. The progression-free survival for those patients in the bendamustine arm was improved over those patients receiving chlorambucil. This information led to the FDA approval of bendamustine for the treatment of CLL. Bendamustine is well tolerated in patients of all age groups.
Indolent NHL is a group of diseases that include mostly follicular lymphoma, in addition to other more rare types such a marginal zone lymphoma, small lymphocytic lymphoma, and lymphoplasmacytic lymphoma. Standard therapy for this group of lymphomas has typically consisted of the combination of an alkylating agent, purine analog, or an anthracycline with rituximab. Bendamustine has been tested in rituximab-resistant indolent NHL patients as a single agent and found to have a high ORR of 74%, with a duration of response of 9.2 months.
Although we have many treatment options for our patients with CLL and indolent NHL, the patients have multiple episodes of remissions and relapses and will need many treatment options over the years of their disease. With the addition of bendamustine for the treatment of indolent NHL and CLL, 1 additional therapeutic has been identified.
With all of these options for therapy, the toxicity profile of the agents becomes an important comparison. In the next article, toxicities of bendamustine will be discussed in detail.