Chemotherapy Drugs
Bendamustine
(ben-da-MUS-teen)
Generic Name: Bendamustine hydrochloride
Trade Name(s): Treanda®
Bendamustine is the generic name for the chemotherapy drug [Treanda ®- with link]. In some cases, health care professionals may use the trade name [Treanda ® - with link] when referring to the generic drug name bendamustine.
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| Drug Type |
[Drug] Precautions |
| What Bendamustine is Used For | [Drug] Self-Care Tips |
| How [Drug] Is Given |
Monitoring While On [Drug] |
| [Drug] Side Effects |
How [Drug] Works |
| When To Contact Doctor |
Bendamustine is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Bendamustine is classified as an "alkylating agent". For more detail, see How Bendamustine Works below.
What Bendamustine Is Used For:
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.
- As an injection into the vein (intravenous, IV).
- There is no pill form of bendamustine.
- The amount of bendamustine that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.
Important things to remember about the side effects of bendamustine:
- Most people will not experience all of the bendamustine side effects listed.
- Bendamustine side effects are often predictable in terms of their onset, duration, and severity.
- Bendamustineside effects are almost always reversible and will go away after therapy is complete.
- Bendamustine side effects may be quite manageable. There are many options to minimize or prevent the side effects of bendamustine.
The following bendamustine side effects are common (occurring in greater than 30%) for patients taking bendamustine:
- Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience lowest blood counts.
Nadir: 14 to 21 days
Recovery: 28 days
- Incease in bilirubin levels
These are less common side effects for patients receiving bendamustine:
- Infusion reaction (chills, fever, itching, rash) may require pre-medications,
- Fever 24
- nausea 20 vomiting 16
- Fatigue 9
- Diarrhea
- Rash
These are rare but serious complications of bendamustine therapy. -
Tumor lysis syndrome may occur as a result of leukemia treatment including treatment with bendamustine. Tumor lysis syndrome occurs when large amounts of cancerous cells are rapidly killed by the therapy. These cells release uric acid, potassium and phosphorus into the blood stream. Tumor lysis syndrome can lead to kidney failure. Tumor lysis syndrome usually occurs within 24 – 48 hours of therapy. Care must be taken to prevent the development of tumor lysis syndrome. Your health care provider will prescribe plenty of fluids to keep you hydrated. You may be given a drug called allopurinol that blocks uric acid production. In some cases, your health care provider may prescribe other measures to lower your white blood count before therapy. Let your health care provider know immediately if you are unable to urinate. Your health care provider will monitor your progress carefully during therapy.
This list includes common and less common side effects for those taking bendamustine. Bendamustine side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. Always inform your health care provider if you experience any unusual symptoms.
When To Contact Your Doctor or Health Care Provider:
Contact your doctor or health care provider immediately, day or night, if you should experience any of the following symptoms:
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- 2
- 3
- 4
- 5
The following symptoms require medical attention, but are not an emergency. Contact your doctor or health care provider within 24 hours of noticing any of the following:
- Nausea (interferes with ability to eat and unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Diarrhea (4-6 episodes in a 24-hour period)
- Unusual bleeding or bruising
- Black or tarry stools or blood in your stools
- Blood in your urine
- Pain or burning with urination
- Extreme fatigue (unable to carry on self-care activities)
- Mouth sores (painful redness, swelling or ulcers)
Always inform your doctor or health care provider if you experience any unusual symptoms.
- Before starting bendamustine treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). While taking bendamustine do not take aspirin or products containing aspirin unless your doctor specifically permits this.
- While taking bendamustine, do not receive any kind of immunization or vaccination without your doctor’s approval.
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (bendamustine may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
- For both men and women: Use contraceptives and do not conceive a child (get pregnant) while taking bendamustine. Barrier methods of contraception such as condoms are recommended.
- Do not breast feed while taking bendamustine.
Self-Care Tips While Taking Bendamustine:
- While taking [Drug], drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- It is important to void (empty your bladder) frequently especially in the first 24 hours after taking [Drug]. Report any pain or burning on urination to your health care provider.
- You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores while taking [Drug], use a soft toothbrush, and rinse three times a day with 1 teaspoon of baking soda mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals while taking [Drug].
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely while you are taking [Drug]. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition while being treated with [Drug].
- If you experience symptoms or side effects while being treated with [Drug], be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
Monitoring and Testing While Taking [Drug]:
You will be checked regularly by your doctor while you are taking [Drug] to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver).
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
Bendamustine is classified as an alkylating agent (nitrogen mustard derivative). Alkylating agents are most active in the resting phase of the cell. Bendamustine is active against resting as well as dividing cells.
Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this web site is meant to be helpful and educational, but is not a substitute for medical advice.
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ADDITIONAL SIDE EFFECTS etc.
- Hair loss
- Poor appetite
- Numbness or tingling of hands or feet
- Peripheral neuropathy: Although uncommon, a serious side effect of decreased sensation and paresthesia (numbness and tingling of the hands and feet) may be noted. Sensory loss, numbness and tingling, and difficulty in walking may last for at least as long as therapy is continued. These side effects may become progressively more severe with continued treatment, and your doctor may decide to decrease your dose.
- Nail changes such as nail thickening or nail banding
- Infertility (loss of fertility). Meaning, your ability to conceive or father a child may be affected by ___________. Discuss this issue with your health care provider.
- Discoloration of the skin or nails (see skin reactions)
- Symptoms of adrenal insufficiency (low production of needed steroids produced by the adrenal glands) are:
- Fatigue, poor appetite, nausea, vomiting, diarrhea, weight loss, weakness, and dizziness. Be sure your health care provider is aware if you are experiencing these symptoms. If adrenal insufficiency occurs replacement steroids may be needed.
- Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia or PPE) – skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet. Usually mild, starting 5-6 weeks after start of treatment. May require reductions in the dose of the medication.
- Darkening of the skin where previous radiation treatment has been given. (radiation recall – see skin reactions)
- Bladder irritation and bleeding (Hemorrhagic cystitis)
- Increases in blood tests measuring liver function. These return to normal once treatment is discontinued. (see liver problems)
- Taste changes, metallic taste.
A serious, but very uncommon side effect of aldesleukin in high doses is "capillary leak syndrome" or "vascular leak syndrome." Capillary leak syndrome is a potentially serious disease in which fluids within the vascular system (veins and capillaries) leaks into the tissue outside the bloodstream. This results in low blood pressure and poor blood flow to the internal organs. Capillary leak syndrome is characterized by the presence of 2 or more of the following 3 symptoms; low blood pressure, swelling, and low levels of protein in the blood. Your doctor will monitor these things carefully while you are taking aldesleukin. You should notify your doctor immediately if you notice dizziness (especially when changing position), sudden swelling or rapid weight gain, little or no urine output (for 8-12 hours), shortness of breath, difficulty breathing, irregular heart beats, or chest pain.
Tumor lysis syndrome may occur as a result of leukemia treatment. Tumor lysis syndrome occurs when large amounts of cancerous cells are rapidly killed by the therapy. These cells release uric acid, potassium and phosphorus into the blood stream. Tumor lysis syndrome can lead to kidney failure. Tumor lysis syndrome usually occurs within 24 – 48 hours of therapy. Care must be taken to prevent the development of tumor lysis syndrome. Your health care provider will prescribe plenty of fluids to keep you hydrated. You may be given a drug called allopurinol that blocks uric acid production. In some cases, your health care provider may prescribe other measures to lower your white blood count before therapy. Let your health care provider know immediately if you are unable to urinate. Your health care provider will monitor your progress carefully during therapy.
A serious, but uncommon side effect of ___________ is veno-occlusive liver disease (VOD). VOD is most common in patients who have been treated with high dose chemotherapy followed by bone marrow or stem cell transplant.VOD is characterized by painful enlarged liver, rapid weight gain from fluid retention, and rising bilirubin levels. Two of the three in a post-treatment setting must be present to establish the diagnosis. Additional testing will reveal elevated liver enzymes (Alkaline phosphatase and GGT); as well as a reversal of blood flow in the veins of the liver on ultrasound. Once VOD occurs, the chances for other organs to fail increases dramatically and potentially fatal multi-organ failure may occur.
Rare but significant side effects may include seizures, convulsions or problems with blood clots. Blood clots can lead to pulmonary embolus or stroke – potentially life-threatening conditions.
- Pancreatitis (inflammation of the pancreas) in up to 10% of patients. Mainly noted in blood tests that return to normal after therapy is discontinued. Rarely may be severe causing symptoms. Symptoms of acute pancreatitis include: (pain in the upper abdomen that worsens with eating, swollen and tender abdomen, nausea, vomiting, fever, and rapid pulse).
- Adrenal insufficiency (low production of needed steroids produced by the adrenal glands). Symptoms of adrenal insufficiency are:
- Fatigue, poor appetite, nausea, vomiting, diarrhea, weight loss, weakness, and dizziness. Be sure your health care provider is aware if you are experiencing these symptoms. If adrenal insufficiency occurs replacement steroids may be needed.
Nadir: 10 –14 days
These are rare but serious complications of busulfan therapy.
Your fertility, meaning your ability to conceive or father a child, may be affected by cisplatin. Please discuss this issue with your health care provider.
Delayed effects:
There is a slight risk of developing a blood cancer such as leukemia years after taking doxorubicin. Talk to your doctor about this risk.
Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
_________ can cause unwanted effects on the heart, including a heart attack. Check with your doctor and/or get emergency help immediately if you experience any signs or symptoms of a heart attack.
- Symptoms of heart attack: anxiety, cold sweating, increased heart rate, severe pain in the chest and/or the jaw, neck, back, or arms, and shortness of breath.
Seek emergency help immediately and notify your health care provider, it you experience the following symptoms:
- Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:
- Fever of 100.5º F (38º C) or higher, chills (possible signs of infection)
- Having thoughts or feeling like you may want to harm yourself or others.
- Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).
The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Diarrhea (4-6 episodes in a 24-hour period).
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools.
- Blood in the urine.
- Pain or burning with urination.
- Extreme fatigue (unable to carry on self-care activities).
- Mouth sores (painful redness, swelling or ulcers).
- Constipation unrelieved by laxative use.
- Swelling, redness and/or pain in one leg or arm and not the other.
- Yellowing of the skin or eyes.
- Tingling or burning, redness, swelling of the palms of the hands or soles of feet.
- Swelling of the feet or ankles. Sudden weight gain.
- Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
- Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.
- Depressed (interfering with your ability to carry on your regular activities).
Always inform your health care provider if you experience any unusual symptoms.
Precautions:
- Before starting ____________ treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor’s approval while taking ____________.
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). Pregnancy category D (___________ may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus.) Pregnancy category X (_________ may cause fetal harm when given to a pregnant woman. This drug must not be given to a pregnant woman or a woman who intends to become pregnant. If a woman becomes pregnant while taking _________, the medication must be stopped immediately and the woman given appropriate counseling).
- For both men and women: Do not conceive a child (get pregnant) while taking _________. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
Self-care tips:
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- It is important to void (empty your bladder) frequently especially in the first 24 hours after taking ___________. Report any pain or burning on urination to your health care provider.
- You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- You may be at risk of infection report fever or any other signs of infection immediately to your health care provider.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with ½ to 1 teaspoon of baking soda and/or ½ to 1 teaspoon of salt mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
- This medication causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
- Prevention of hand-foot syndrome. Modification of normal activities of daily living to reduce friction and heat exposure to hands and feet, for about a week after treatment. (for more information see - Managing side effects: hand foot syndrome)
- Keep palms of hands and soles of feet moist using emollients.
- Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by this medicine.
- You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
- If you are experiencing hot flashes, wearing light clothing, staying in a cool environment, and putting cool cloths on your head may reduce symptoms. Consult you health care provider if these worsen, or become intolerable.
- For flu-like symptoms, keep warm with blankets and drink plenty of liquids. There are medications that can help reduce the discomfort caused by chills.
- Acetaminophen or ibuprophen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it.
Monitoring and testing:
You will be checked regularly by your health care professional while you are taking __________, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.
How this drug works:
Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.
