Risk Factors for Skin Toxicities Associated with Bendamustine-Based Chemotherapy in Patients with Non-Hodgkin Lymphoma

Abstract

Bendamustine plays an especially important role as a treatment for non-Hodgkin lymphoma (NHL). However, patients administered bendamustine alone or in combination with rituximab (BR) may experience drug-associated skin toxicities that can profoundly impact their health-related QOL through both physical discomfort and psychological distress. Moreover, worsening skin symptoms may lead to dose reduction or termination in the management of cancer chemotherapy. We retrospectively investigated patient backgrounds and pretreatment characteristics from medical records of NHL patients treated with bendamustine alone or BR therapy and identified predictive factors for skin toxicities at the start of chemotherapy. Patients were eligible for the study if they were 20 years older, diagnosed with NHL, and received bendamustine alone or BR therapy at the Department of Hematology, Kobe City Medical Center General Hospital, between April 1, 2011, and March 31, 2018. This study included 95 patients with newly diagnosed or refractory or relapsed NHL. Multivariate stepwise logistic regression analysis with backward selection revealed that baseline non-prior chemotherapy (odds ratio (OR), 15.72; 95% confidence interval (CI), 4.24-83.13, p < 0.001) was a significant factor influencing the occurrence of skin toxicity. Our results demonstrated that non-prior chemotherapy was a significant risk factor for skin toxicities in patients with NHL receiving bendamustine alone or BR therapy. No patient experience serious side effects of grade 3 or higher and that bendamustine is very useful as a first-line treatment.

Bendamustine-induced rash is associated with a favorable prognosis in patients with indolent B-cell lymphoma

“…Uchida et al analyzed 95 patients with non-Hodgkin's lymphoma who received bendamustine alone or BR therapy and reported that no prior treatment was a significant factor in skin toxicity. 16 In our study, 13/20 (65%) newly diagnosed patients developed rash and 14/45 (31%) relapsed/ refractory patients developed rash, demonstrating a signifi- Table 3. Characteristics of patients who developed rash after bendamustine and those who did not WHO, World Health Organization; MALT, mucosa-associated lymphoid tissue; WBC, white blood cell cant difference (p=0.0147).…”

Two‐year outcomes of tirabrutinib monotherapy in Waldenström’s macroglobulinemia

“…Recently, Uchida and colleagues reported that non‐prior chemotherapy was a significantly high‐risk factor for skin toxicities in patients with NHL receiving bendamustine alone or with rituximab. 36 The underlying mechanism was not clarified; however, they speculated that T‐cell function was maintained in chemotherapy‐naïve patients compared with that in relapsed or refractory patients. Regarding skin AEs in tirabrutinib, further studies would be required.…”

“…Additionally, the rate of skin AEs was obviously higher in Cohort A in the present study. Recently, Uchida and colleagues reported that non‐prior chemotherapy was a significantly high‐risk factor for skin toxicities in patients with NHL receiving bendamustine alone or with rituximab 36 …”

Post-marketing risk analysis of bendamustine: a real-world approach based on the FAERS database

“…However, adverse effects such as fever, memory loss, anxiety, and rash have been noted during or after discontinuation of treatment ( Yi et al, 2022 ). Furthermore, serious complications like progressive multifocal leukoencephalopathy (PML) have been reported, including a case in a patient with non-Hodgkin follicular lymphoma post hematopoietic stem cell transplantation and rituximab-bendamustine therapy, where JC Virus DNA was detected in both peripheral blood and cerebrospinal fluid ( Uchida Trociukas et al, 2020 ). A retrospective study of 95 patients also highlighted non-prior chemotherapy as a significant risk factor for skin toxicities among NHL patients treated with bendamustine alone or in combination with rituximab (BR therapy).…”