Chemo Experts, the easiest way to learn about cancer treatment
Find a Treatment:
Cancer Types
or
Treatments
listen

Tap along the timeline to move to different parts of the audio file.

Treatment Name: Bendamustine (Bendeka®) + Rituximab (Rituxan®)

Bendamustine (Bendeka®) + Rituximab (Rituxan®) is a Chemotherapy Regimen for Chronic Lymphocytic Leukemia (CLL)

How does bendamustine + rituximab work?
Bendamustine is designed to kill existing cancer cells and slow the growth of new cancer cells. Rituximab is designed to bind to a specific protein on the surface of cancerous cells, specifically B-lymphocytes, and target these cells for destruction by your own immune system.

Goals of therapy:
Bendamustine + rituximab is given to decrease symptoms of CLL such as enlarged or swollen lymph nodes, enlarged liver or spleen, or symptoms of abnormal bone marrow function, such as frequent infections. Bendamustine + rituximab may not cure CLL, but is given with the goal of keeping CLL in remission for months or even years.

Alternative names:
R-Benda and B-R

listen

Tap along the timeline to move to different parts of the audio file.

Schedule

  • Bendamustine intravenous (I.V.) infusion is given over 10 minutes on Day 1 and Day 2
  • Rituximab I.V. infusion given on Day 1. The time of infusion varies depending upon tolerability

Estimated total infusion time for this treatment:

  • Up to 8 hours for Cycle 1, Day 1; as short as three hours for the first day of Cycles 2 through 6, if well tolerated. Day 2 of each cycle can take as short as one hour
  • Infusion times are based upon clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time

Bendamustine + Rituximab is usually given in an outpatient infusion center, allowing the person to go home afterwards. On occasion, it may be given in the hospital if someone is too sick.

Bendamustine + Rituximab is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated up to six times. All six cycles may take more than six months to receive, depending upon response, and tolerability.

Click here for common starting doses.

listen

Tap along the timeline to move to different parts of the audio file.

Side Effects

In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects with bendamustine + rituximab are shown here. Side effects sometimes have percentage ranges [example: 22 – 28%] because they differed between clinical studies:

  • Increased bleeding risk [low platelets; thrombocytopenia] (22 - 28%)
  • Low white blood cells; may increase infection risk (20 - 23%)
  • Anemia [low red blood cells] (17 - 20%)
  • Infections [including neutropenic fever] (8 - 13%)
  • Allergic reaction (3 - 10%)
  • Tumor lysis syndrome (3%)
  • Destruction of red blood cells [hemolysis]; may lead to anemia (2 - 3%)
  • Nausea or vomiting (exact percentage not reported)

On average, roughly 4% of patients (1 in 25) discontinue therapy due to unacceptable side effects.

Side effect videos Side Effect Videos
BleedingBleedingNeutropenic FeverNeutropenic FeverAnemiaAnemiaNausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue PainPain

listen

Tap along the timeline to move to different parts of the audio file.

Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before each treatment and periodically during treatment at the discretion of your doctor. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lactate Dehydrogenase (LDH), phosphorous, uric acid, plus any others your doctor may order. Hepatitis B screening and Human Immunodeficiency Virus (HIV) screening may also be done before starting treatment.

How often is imaging needed?
Imaging may be checked before treatment begins, or as recommended by your doctor. Imaging may include: X-rays, magnetic resonance imaging (MRI), or computerized tomography (CT) scans. Re-imaging scans may be recommended after Cycle 3 and Cycle 6 to assess response to chemotherapy.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue bendamustine + rituximab as planned, or delay treatment or switch to an alternative therapy.

listen

Tap along the timeline to move to different parts of the audio file.

ChemoExperts Tips

  • Premedications such as diphenhydramine (Benadryl®), acetaminophen (Tylenol®), and hydrocortisone (Solu-Cortef®) may be given before rituximab to help avoid infusion related reactions
  • The first dose of rituximab is often the hardest. It may lead to fever, shaking, and chills even if premedications are given to help prevent this. Reactions generally go away when the rituximab is stopped. It may be restarted at a slower rate. Most patients are able to receive the entire dose, although it may take longer. In some cases, after the first dose, it can be give over as short as 90 minutes
  • May cause mild irritation to the vein during infusion
  • A white blood cell growth factor was used to help prevent infection in roughly 20% of patients in the clinical studies. Your doctor may prescribe this injection to help prevent serious infections such as pneumonia
  • Let your doctor know if you are allergic to polyethylene glycol 400, propylene glycol, or monothioglycerol before receiving bendamustine as this is a related ingredient in the drug product
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for CLL. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Bendamustine (Bendeka®) + Rituximab (Rituxan®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Bendamustine (Bendeka®) + Rituximab (Rituxan®). Depending upon your income, they may be able to help cover the cost of:

  • Bendamustine
  • Rituximab

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Bendamustine (Bendeka®) + Rituximab (Rituxan®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Bendamustine (Bendeka®) + Rituximab (Rituxan®)

Individual Drug Label Information

Bendamustine (Bendeka®)

  • Bendamustine is an intravenous infusion
  • Dosage adjustments may be required for low white blood cells, low red blood cells, low platelets, or decreased kidney function 
  • Let your doctor know if you are allergic to polyethylene glycol 400, propylene glycol, or monothioglycerol
  • May cause birth defects if given during pregnancy. Use effective contraception during treatment and for 3 months following treatment
General Bendamustine (Bendeka) Side Effects
  • Fatigue
  • Skin rash or itching
  • Mild nausea or vomiting
  • Low red blood cells, white blood cells, or platelets may occur during treatment
  • Diarrhea
  • Neutropenic fever 
  • May cause mild irritation to the vein during infusion 
  • Serious infusion related reactions such as rash, swelling, and trouble breathing can occur 
  • Although rare, may increase your risk of developing blood-related cancers such as acute myeloid leukemia (AML), myelodysplastic syndrome (MDS) or myeloproliferative disorders (essential thrombocytosis, polycythemia vera, myelofibrosis)
  • Does not usually cause hair loss, and if hair loss does occur, it is usually not complete hair loss 
  • Click on the bendamustine (Bendeka) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaHair LossHair LossFatigue Fatigue PainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

Rituximab (Rituxan®)

  • Rituximab is an intravenous infusion
  • Acetaminophen (Tylenol®) and antihistamines (e.g. diphenhydramine = Benadryl®) should be given prior to each dosePatients should be screened for hepatitis B as rituximab can cause a re-activation of this infection
  • May cause vaccines to work less well. It is advised that vaccines be given two to four weeks prior to rituximab if possible
General Rituximab (Rituxan) Side Effects
  • May cause an infusion reaction, which could include skin reaction, shaking, chills, fever, or shortness of breath. These reactions may be severe, but are very rarely life-threatening
  • Infusion reactions does not usually happen after the first dose, but are possible
  • May increase the risk of infection. Your doctor may prescribe antibiotics to prevent certain infections associated with rituximab use
  • Click on the rituximab (Rituxan) package insert below for reported side effects and potential drug Interactions
See DailyMed package insert.

Share this page:

References

1) Fischer K, Cramer P, Busch R, et al. Bendamustine combined with rituximab in patients with relapsed and/or refractory chronic lymphocytic leukemia: a multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol. 2011;29:3559-3566.

2) Fischer K, Cramer P, Busch R, et al. Bendamustine in combination with rituximab for previously untreated patients with chronic lymphocytic leukemia: a multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol. 2012;30:3209-3216.

Created: July 5, 2016 Updated: January 23, 2017

What is Chronic Lymphocytic Leukemia (CLL)?

Chronic Lymphocytic Leukemia (CLL) is the most common type of leukemia diagnosed in adults. It is a cancer of the B-lymphocyte. In rare cases, CLL may be hereditary, but most causes are unknown. The stage of CLL can vary at diagnosis and throughout treatment. Stages of CLL include Rai stage 0, I, II, III, or IV. Many therapies are not curative, however, newer therapies are able to suppress the cancer for many months or even years.

Medications for CLL may include intravenous infusions, oral tablets or capsules, or a combination of IV and oral medications. Patients may be diagnosed with CLL without having any symptoms. Others may go to their doctor with symptoms of fatigue, a large spleen, or decreased appetite. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Common Starting Doses

Exact infusion times may vary depending upon tolerability.

  • Bendamustine 70 mg/m2, 90 mg/m2, or 100 mg/m2 intravenous (I.V.) infusion over ten minutes on Day 1 and Day 2 of each cycle
  • Rituximab 375 mg/m2 I.V. on Day 1 of Cycle 1 only
  • Rituximab 500 mg/m2 I.V. on Day 1 of Cycles 2 - 6 
    • On occasion, the rituximab dose may be split between Day 1 and Day 2 to lessen the risk of infusion-related reactions
  • Cycles are often repeated every four weeks (28 days), if tolerated

Note: Individual doses may vary based upon your doctor's recommendation, tolerability, or drug availability.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Fischer K, Cramer P, Busch R, et al. Bendamustine combined with rituximab in patients with relapsed and/or refractory chronic lymphocytic leukemia: a multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol. 2011;29:3559-3566.

2) Fischer K, Cramer P, Busch R, et al. Bendamustine in combination with rituximab for previously untreated patients with chronic lymphocytic leukemia: a multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol. 2012;30:3209-3216.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium