Bendamustine in the treatment of non-Hodgkin's lymphoma: results and future perspectives.

Bendamustine has clinical potential in the treatment of low-grade non-Hodgkin's lymphoma (NHL). As a single agent, bendamustine has been used in two studies in patients with relapsed or refractory low-grade NHL. When bendamustine 120 mg/m(2) was given on days 1 and 2, the overall response rate was 73% with complete responses in 11%. When bendamustine 50 to 60 mg/m(2) was given on days 1 through 5, the overall response rate was 82.5%, with 14.5% complete responses. Bendamustine shows only partial cross-resistance with other agents used in the treatment of NHL and combination regimens have been investigated. The combination of bendamustine/vincristine/prednisolone (BOP) has been compared with cyclophosphamide/vincristine/prednisolone (COP) in a phase III study involving 162 patients with low-grade NHL. No differences were seen between the treatment arms with regard to response rate or survival, but the BOP regimen was significantly better tolerated than the COP regimen. The combination of rituximab/bendamustine has shown encouraging activity in patients with relapsed/refractory NHL and a trial is ongoing in which this combination is used in patients with advanced low-grade NHL or mantle cell lymphoma. Preliminary results from this trial are presented. The 93% overall response rate attained in the patients presently evaluable indicates that this combination is very active in this poor-prognosis population. Optimal treatment regimens with bendamustine in the treatment of low-grade NHL are yet to be defined, but results obtained to date indicate that further studies are warranted.