Feasibility of bendamustine in elderly patients with b-cell non hodgkin lymphomas

Abstract

Background: Bendamustine, an old powerful alkylating agent with potential antimetabolite properties, has demonstrated efficacy in patients ( pts) with indolent and aggressive B cell non-Hodgkin lymphomas (NHLs), including chronic lymphocytic leukemia (CLL). Bendamustine alone or in combination with rituximab, is associated with haematologic toxicity and risk of infections: this is particularly important in the elderly pts, more susceptible than the younger population. We want evaluate the feasibility of bendamustine in 1st line and at relapse in NHL in pts over 65 years, in which incidence increases markedly with age. Material and methods: Between January 2012 and December 2014, 13 outpatients, 7 F (54%) and 6 M (46%) with NHLs, aged 66-88 years (median 77) were admitted to SOC Oncologia in Santo Spirito Hospital of Casale Monferrato. There were not frail pts at evaluation with G8 test performed at the first interview. Charlston Comorbidity Index (CCI) score was 3-7 (median 4) determined more advanced age than for the concomitant illness. 2 women were chemotreated in adiuvant setting with CMF for breast cancer some years before. ECOG PS was 0 (38%) or 1 (62%). 6 pts (46%) had large cell, 3 (23%) follicular NHLs and 4 (31%) LLC. Stage: IIE 1 pt (8%), III 9 (69%), IV 3 (23%). 4 pts (31%) were pretreated and in relapse. All were treated with bendamustine 60-90 mg/m2 (in relation to CCI, G8 score and physician's expertise), 60-minutes intravenous infusion, days 1 and 2 every 4 weeks for 4-6 courses, 11 (85%) in association with rituximab. We want evaluate safety and tolerability of bendamustine in NHLs in 1st and 2nd line in elderly pts. Antiemetic and opportunistic infections prophylaxis was performed. Results: Complete and partial remission was observed respectively in 7 (54%) and 2 (15%) pts, progression in 3 (23%). The treatment was well tolerated and it did not affected the quality of life. Neutropenia was the most frequently reported toxicity with grade 3 in 31% of all treatment cycles. Other grade 3-4 toxic effects were rather low, with anemia in 7% and thrombocytopenia in 2% of the total treatment cycle. 1 pt developed herpes zoster. Conclusions: Bendamustine treatment is associated with a good therapeutic performance and are increasing use alone or in combination with rituximab for its activities in lymphoid malignancies with high response rate. In elderly setting this drug can be considered safety and well tolerated both in 1st line and in retreatment.