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Safety of bendamustine for the treatment of indolent non-Hodgkin lymphoma: a UK real-world experience

Shotton, Rohan; Broadbent, Rachel; Alchawaf, Alia; Mohamed, Mohamed Bakri; Gibb, Adam; Martinez-Calle, Nicolás; Fox, Christopher P.; Bishton, Mark; Pender, Alexandra; Gleeson, Mary; Cunningham, David; Davies, Andrew John; Yadollahi, Sina; Eyre, Toby A.; Collins, Graham P.; Djebbari, Faouzi; Kassam, Shireen; Garland, Paula; Watts, Emily; Osborne, Wendy; Townsend, Wiliam M.; Pocock, Rachael; Ahearne, Matthew J.; Miall, Fiona; Wang, Xin; Linton, Kim M.

Safety of bendamustine for the treatment of indolent non-Hodgkin lymphoma: a UK real-world experience Thumbnail


Rohan Shotton

Rachel Broadbent

Alia Alchawaf

Mohamed Bakri Mohamed

Adam Gibb

Nicolás Martinez-Calle

Mark Bishton

Alexandra Pender

Mary Gleeson

David Cunningham

Andrew John Davies

Sina Yadollahi

Toby A. Eyre

Graham P. Collins

Faouzi Djebbari

Shireen Kassam

Paula Garland

Emily Watts

Wendy Osborne

Wiliam M. Townsend

Rachael Pocock

Matthew J. Ahearne

Fiona Miall

Xin Wang

Kim M. Linton


Bendamustine is among the most effective chemotherapeutics for indolent B-cell non- Hodgkin lymphomas (iNHL), but trial reports of significant toxicity, including opportunistic infections and excess deaths, led to prescriber warnings. We conducted a multicenter observational study evaluating bendamustine toxicity in real-world practice. Patients receiving at least 1 dose of bendamustine with/without rituximab (R) for iNHL were included. Demographics, lymphoma and treatment details, and grade 3 to 5 adverse events (AEs) were analyzed and correlated. In total, 323 patients were enrolled from 9 National Health Service hospitals. Most patients (96%) received bendamustine-R, and 46%, R maintenance. Overall, 21.7% experienced serious AEs (SAE) related to treatment, including infections in 12%, with absolute risk highest during induction (63%), maintenance (20%), and follow-up (17%) and the relative risk highest during maintenance (54%), induction (34%), and follow-up (28%). Toxicity led to permanent treatment discontinuation for 13% of patients, and 2.8% died of bendamustine-related infections (n = 5), myelodysplastic syndrome (n = 3), and cardiac disease (n = 1). More SAEs per patient were reported in patients with mantle cell lymphoma, poor preinduction performance status (PS), poor premaintenance PS, and abnormal preinduction total globulins and in those receiving growth factors. Use of antimicrobial prophylaxis was variable, and 3 of 10 opportunistic infections occurred despite prophylaxis. In this real-world analysis, bendamustine-related deaths and treatment discontinuation were similar to those of trial populations of younger, fitter patients. Poor PS, mantle cell histology, and maintenance R were potential risk factors. Infections, including late onset events, were the most common treatment-related SAE and cause of death, warranting extended antimicrobial prophylaxis and infectious surveillance, especially for maintenance-treated patients.


Shotton, R., Broadbent, R., Alchawaf, A., Mohamed, M. B., Gibb, A., Martinez-Calle, N., …Linton, K. M. (2023). Safety of bendamustine for the treatment of indolent non-Hodgkin lymphoma: a UK real-world experience. Blood Advances, 8(4), 878-888.

Journal Article Type Article
Acceptance Date Oct 18, 2023
Online Publication Date Nov 15, 2023
Publication Date Nov 15, 2023
Deposit Date Nov 22, 2023
Publicly Available Date Nov 22, 2023
Journal Blood Advances
Electronic ISSN 2473-9529
Publisher American Society of Hematology
Peer Reviewed Peer Reviewed
Volume 8
Issue 4
Pages 878-888
Keywords Hematology
Public URL
Publisher URL


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