Successful Management of Adverse Events in a Case of Follicular Lymphoma Treated with Bendamustine as Outpatient Cancer Chemotherapy

Abstract

Bendamustine is an anti-cancer drug approved for relapse or refractory indolent B cell lymphoma. Although it is a promising drug because it shows a different activity pattern from other alkylating agents and a lack of crossresistance with them, there is insufficient evidence to standardize the regimen including supportive care, particularly at outpatient cancer chemotherapy. In our hospital, bendamustine (120 mg/m 2) was administered to a patient with follicular lymphoma. Cycle 1 treatment was performed under hospitalization, followed by cycles 2 to 4 under outpatient cancer chemotherapy. For prophylaxis of nausea and vomiting, azasetron, dexamethasone and aprepitant were used. At outpatient cancer chemotherapy, dexamethasone was orally administered on days after bendamustine injection. No nausea or vomiting was observed throughout all cycles. However, on cycle 1, myelosuppression including grade 4 leukopenia and grade 2 thrombocytopenia were observed. Therefore, the dosage of bendamustine on cycles 2 to 4 was reduced to 90 mg/m 2. During outpatient cancer chemotherapy, mild myelosuppression was observed, but chemotherapy could be achieved without delay by treatment with granulocyte-colony stimulating factor (G-CSF) or antibiotics. In this case, the bendamustine regimen could be safely performed without severe adverse events except myelosuppression, indicating that this report may be a good reference in the management of supportive care for safe administration of bendamustine.