Bendamustine is a chemotherapy drug that is sometimes given to treat chronic lymphocytic leukaemia (CLL), non-Hodgkin lymphoma (NHL) and myeloma. It should ideally be read with our general information about chemotherapy and your type of cancer.
You will see your hospital doctor regularly while you have this treatment so they can monitor its effects.
What bendamustine looks like
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Bendamustine is a white powder that is dissolved into a clear fluid.
Bendamustine is given as a drip (intravenous infusion) in one of the following ways:
through a fine tube inserted into a vein, usually in the back of your hand (cannula)
through a fine, plastic tube inserted under the skin near your collarbone (central line)
through a fine tube inserted into the crook of your arm (PICC line).
The infusion usually takes between 30-60 minutes.
Chemotherapy is usually given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you are being treated for. Your nurse or doctor will discuss your treatment plan with you.
Bendamustine is licensed and can be prescribed in the UK.
The National Institute for Health and Clinical Excellence (NICE) is an independent body that currently gives advice on which new drugs or treatments should be available on the NHS. The Scottish Medicines Consortium (SMC) is an organisation similar to NICE for the NHS in Scotland. Both NICE and the SMC recommend that bendamustine can be given as a first treatment for CLL, but only if patients are unable to have another chemotherapy drug called fludarabine.
For people who have NHL, bendamustine is only licensed to be given if the lymphoma has come back after treatment with a drug called rituximab. However, NICE and the SMC do not currently recommend that bendamustine should be made available on the NHS in this situation.
For people with myeloma, bendamustine is only licensed for patients who are unable to have high-dose chemotherapy and a stem cell transplant, or aren’t able to have drugs called bortezomib and thalidomide. Currently there are no NICE guidelines about whether bendamustine should be made available on the NHS in this situation. The SMC do not currently recommend that bendamustine be made available in this situation.
Your doctor can let you know whether bendamustine would be suitable in your situation.
You can read our section on access to cancer treatment for more information on the availability of cancer treatments.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who has bendamustine and may be different if you’re having more than one type of chemotherapy drug.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that are not listed here, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Bendamustine can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
Bendamustine can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Bendamustine can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Some people have an allergic reaction to bendamustine while it’s being given. Signs of this include flu-like symptoms (such as headache, fever or chills), feeling sick, skin rashes and itching, breathlessness, or pain in your back, tummy or chest.
It‘s most common with the first infusion, so the first dose is given slowly over a number of hours. You’ll also be given medicines before the treatment to help prevent or reduce any reaction. You’ll be monitored closely during your infusion but it's important to tell your nurse or doctor if you feel unwell or have any of the above symptoms. If you do have a reaction, it can be treated quickly.
Sometimes a reaction can happen a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre and doing some gentle exercise. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them at a pharmacy.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Some people may find sucking on ice soothing.
Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections. You may find our section on mouth care during chemotherapy helpful.
Feeling sick (nausea) or being sick (vomiting)
This is usually mild. If you do feel sick, it may begin a few hours after treatment and last for a few days.
Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight. You might find our section on eating well useful.
This is unusual with this treatment, but your hair may become thinner. If you lose any hair it will grow back once the treatment has finished. Your nurse can give you advice about coping with hair loss.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
Your kidneys may be affected
This doesn't usually cause any symptoms and the effect is generally mild. Your kidneys will be checked by a blood test before each treatment.
Less common side effects
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Effects on the heart
Bendamustine can sometimes cause changes to the rhythm of your heart. These changes are usually mild. If you feel your heart is beating faster than normal, feel dizzy or have chest pain you should tell your doctor immediately.
High blood pressure
Bendamustine can sometimes cause high blood pressure. You should let your doctor know if you already have high blood pressure before starting this treatment. Your blood pressure will be monitored regularly to check for any changes.
Changes to the lungs
The chemotherapy may cause some changes to the lungs. Tell your doctor if you smoke or if you notice any coughing or breathlessness.
A skin rash can sometimes occur while you are having treatment with bendamustine. It’s important to let your doctor know if this happens, as they can prescribe medicine to help with this.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood.The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having this type of chemotherapy.
Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It's not advisable to become pregnant or father a child while taking bendamustine, as it may harm the developing baby. It’s important to use effective contraception while taking this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
This information is based on our Bendamustine (Levact®) fact sheet and has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
British National Formulary. 62nd edition. March 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Bendamustine for the first-line treatment of chronic lymphocytic leukaemia. February 2010. National Institute for Health and Clinical Excellence (NICE).
UpToDate. www.uptodate.com (accessed March 2011).
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
Chaber BA, Longo L. Cancer Chemotherapy and Biotherapy: Principles and Practice. 5th Edition. 2011. Lippincott Williams and Wilkins.