Contributions
Abstract: PB2037
Type: Publication Only
Background
Bendamustine-based regimens belong to most effective treatments for indolent lymphoid malignancies but reports on its toxicities vary.
Aims
To compare efficacy and toxicity of bendamustine-based regimens in a real-world situation to those reported in the literature and to identify possible risk factors for development of complications.
Methods
We performed a retrospective chart review of all our patients with CLL, indolent NHLs (iNHL) and mantle cell lymphoma (MCL) treated with bendamustine-based regimens between 2013 and 2017.
Results
123 patients, 36-88 (median 67) years old, were included in this analysis. 65 were male and 58 female. 51 were younger than 65 y and 19 older than 75 y. 35 had chronic lymphocytic leukemia (CLL), 35 follicular lymphoma (FL), 19 marginal zone lymphoma (MZL), 14 lymphoplasmocytic lymphoma (LPL) and 20 MCL. 63 were treated in 1st, 42 in 2nd and 18 patients in subsequent lines of treatment. 103 patients received BR or similar, 19 R-BAC and 1 bendamustine monotherapy. Median follow-up was 14 mo.
Response rates (RR), progression-free survival (PFS) and overall survival were similar to those reported in seminal studies. RR in 1 st line was 87% for CLL, 93% for indolent NHL (iNHL) and 80% for MCL. In later lines RR was 85%, 72% and 67% respectively. 18-mo PFS was 83% in 1st line CLL and 91% in iNHL, and 77% and 68% respectively in 2nd line. Hematological toxicity was also similar to that reported; in 1st line gr 3-4 neutropenia occurred in 20%, thrombocytopenia in 8% and anemia in 8% of patients. In later treatment lines gr 3-4 neutropenia occurred in 30%, thrombocytopenia in 11% and anemia in 10% of patients. Skin changes were mild, serious gastrointestinal toxicity occurred in 3% of patients. Infections were substantially more frequent than reported in the NHL1 and NHL2 studies, but not in CLL10. In 1st line of treatment gr 1-2 infections occurred in 38% and gr 3-4 in 22% of patients, and in later treatment lines in 30% and 30% respectively. Risk of serious infections was significantly higher in pts. previously treated with ≥2 lines (50% vs. 23%, p=0,02) and those with reduced IgG levels at end of treatment (36% vs. 14%, p=0.015). Risk of infections of all grades was higher in those with IgG<4 g/L (82% vs. 59%, p=0.018); there was a trend in pts older than 75 (79% vs. 57%, p=0.076). Sex, disease type, initial IgG levels and antimicrobial prophylaxis did not significantly influence infection risk. 5 1st line pts died of toxicity and 2 of lymphoma in comparison to 7 and 6 in later treatment lines. Infections clustered during first two cycles and after end of therapy. Four pts. developed secondary malignancies.
Conclusion
Efficacy of bendamustine-based regimens in routine clinical practice is similar to that reported in randomized studies, but infections are more frequent. Low IgG levels, advanced age and having received more than 2 lines of therapy increase the risk. Increased risk persists after end of therapy.
Session topic: 20. Indolent Non-Hodgkin lymphoma – Clinical
Keyword(s): B cell chronic lymphocytic leukemia, bendamustine, Indolent Non-Hodgkin's Lymphoma, Infection
Abstract: PB2037
Type: Publication Only
Background
Bendamustine-based regimens belong to most effective treatments for indolent lymphoid malignancies but reports on its toxicities vary.
Aims
To compare efficacy and toxicity of bendamustine-based regimens in a real-world situation to those reported in the literature and to identify possible risk factors for development of complications.
Methods
We performed a retrospective chart review of all our patients with CLL, indolent NHLs (iNHL) and mantle cell lymphoma (MCL) treated with bendamustine-based regimens between 2013 and 2017.
Results
123 patients, 36-88 (median 67) years old, were included in this analysis. 65 were male and 58 female. 51 were younger than 65 y and 19 older than 75 y. 35 had chronic lymphocytic leukemia (CLL), 35 follicular lymphoma (FL), 19 marginal zone lymphoma (MZL), 14 lymphoplasmocytic lymphoma (LPL) and 20 MCL. 63 were treated in 1st, 42 in 2nd and 18 patients in subsequent lines of treatment. 103 patients received BR or similar, 19 R-BAC and 1 bendamustine monotherapy. Median follow-up was 14 mo.
Response rates (RR), progression-free survival (PFS) and overall survival were similar to those reported in seminal studies. RR in 1 st line was 87% for CLL, 93% for indolent NHL (iNHL) and 80% for MCL. In later lines RR was 85%, 72% and 67% respectively. 18-mo PFS was 83% in 1st line CLL and 91% in iNHL, and 77% and 68% respectively in 2nd line. Hematological toxicity was also similar to that reported; in 1st line gr 3-4 neutropenia occurred in 20%, thrombocytopenia in 8% and anemia in 8% of patients. In later treatment lines gr 3-4 neutropenia occurred in 30%, thrombocytopenia in 11% and anemia in 10% of patients. Skin changes were mild, serious gastrointestinal toxicity occurred in 3% of patients. Infections were substantially more frequent than reported in the NHL1 and NHL2 studies, but not in CLL10. In 1st line of treatment gr 1-2 infections occurred in 38% and gr 3-4 in 22% of patients, and in later treatment lines in 30% and 30% respectively. Risk of serious infections was significantly higher in pts. previously treated with ≥2 lines (50% vs. 23%, p=0,02) and those with reduced IgG levels at end of treatment (36% vs. 14%, p=0.015). Risk of infections of all grades was higher in those with IgG<4 g/L (82% vs. 59%, p=0.018); there was a trend in pts older than 75 (79% vs. 57%, p=0.076). Sex, disease type, initial IgG levels and antimicrobial prophylaxis did not significantly influence infection risk. 5 1st line pts died of toxicity and 2 of lymphoma in comparison to 7 and 6 in later treatment lines. Infections clustered during first two cycles and after end of therapy. Four pts. developed secondary malignancies.
Conclusion
Efficacy of bendamustine-based regimens in routine clinical practice is similar to that reported in randomized studies, but infections are more frequent. Low IgG levels, advanced age and having received more than 2 lines of therapy increase the risk. Increased risk persists after end of therapy.
Session topic: 20. Indolent Non-Hodgkin lymphoma – Clinical
Keyword(s): B cell chronic lymphocytic leukemia, bendamustine, Indolent Non-Hodgkin's Lymphoma, Infection