# Bendamustine

Source: https://onco.cc/drugs/bendamustine/  
OnCo record `bendamustine` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

An East German chemotherapy rediscovered in the 2000s that became the backbone partner for rituximab in follicular, mantle cell and Waldenström lymphomas.

## Summary

Approved 2008 for CLL and rituximab-refractory indolent NHL. StiL and BRIGHT trials showed bendamustine-rituximab at least as effective as R-CHOP with less alopecia and neuropathy, making BR the most common first-line indolent lymphoma regimen. Prolonged lymphopenia and infections (PJP, CMV) are the main concerns; combined with obinutuzumab (GALLIUM) or acalabrutinib (ECHO).

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-08
- Tags: gap-fill; generic
- Brand: Treanda / Bendeka / Belrapzo
- Modality: Alkylating agent (nitrogen mustard-purine hybrid)
- Mechanism: Bifunctional alkylator causing DNA cross-links with a benzimidazole ring conferring purine-analogue-like properties; less cross-resistance with other alkylators.
- Approvals: US 2008: CLL; indolent B-cell NHL progressed within 6 months of rituximab; EU 2010: CLL, indolent NHL, multiple myeloma (national approvals)

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Bendamustine
- StiL NHL1 (Lancet 2013): https://doi.org/10.1016/S0140-6736(12)61763-2
- Label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=bendamustine

## Connected records

- cancers: [Chronic lymphocytic leukaemia](https://onco.cc/cancers/cll/), [Chronic lymphocytic leukaemia, first treatment](https://onco.cc/cancers/cll-treatment-naive/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)](https://onco.cc/cancers/malt-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Gastric MALT lymphoma](https://onco.cc/cancers/gastric-malt-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Nodal marginal zone lymphoma](https://onco.cc/cancers/nodal-marginal-zone-lymphoma/), [Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)](https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Ocular adnexal MALT lymphoma](https://onco.cc/cancers/ocular-adnexal-malt-lymphoma/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant)](https://onco.cc/cancers/splenic-b-cell-lymphoma-leukaemia-prominent-nucleoli/), [Splenic marginal zone lymphoma](https://onco.cc/cancers/splenic-marginal-zone-lymphoma/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- companies: [Lupeng Pharmaceuticals](https://onco.cc/companies/lupeng-pharmaceuticals/), [Mundipharma](https://onco.cc/companies/mundipharma/), [SymBio Pharmaceuticals](https://onco.cc/companies/symbio-pharmaceuticals/)
- trials: [A Global Phase 3 Study of Orelabrutinib+BR Vs.BR in Pts with TN MCL](https://onco.cc/trials/nct06363994/), [A Study of Acalabrutinib vs Investigator's Choice of Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in R/R CLL](https://onco.cc/trials/nct02970318/), [A Study of BGB-16673 Compared to Investigator's Choice in Participants With Relapsed/Refractory Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma Previously Exposed to Covalent Bruton Tyrosine Kinase (BTK) Inhibitors](https://onco.cc/trials/nct06970743/), [A Study of BR Alone Versus in Combination With Acalabrutinib in Subjects With Previously Untreated MCL](https://onco.cc/trials/nct02972840/), [A Study of Duvelisib Versus Gemcitabine or Bendamustine in Participants With Relapsed/Refractory Nodal T Cell Lymphoma With T Follicular Helper (TFH) Phenotype](https://onco.cc/trials/nct06522737/), [A Study of Nemtabrutinib vs Chemoimmunotherapy for Participants With Previously Untreated Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) Without TP53 Aberrations (MK-1026-008, BELLWAVE-008)](https://onco.cc/trials/nct05624554/), [A Study of Pirtobrutinib (LOXO-305) Versus Bendamustine Plus Rituximab (BR) in Untreated Patients With Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)](https://onco.cc/trials/nct05023980/), [A Study of Rocbrutinib in Participants With Relapse or Refractory Non-GCB Diffuse Large B-Cell Lymphoma](https://onco.cc/trials/nct07189065/), [A Study of Tacabrutideg (BGB-16673) Compared to Investigator's Choice in Participants With Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma Previously Exposed to Both Bruton Tyrosine Kinase (BTK) and B-cell Leukemia/Lymphoma 2 Protein (BCL2) Inhibitors](https://onco.cc/trials/nct06846671/), [A Study to Evaluate Glofitamab as a Single Agent vs. Investigator's Choice in Participants With Relapsed/Refractory Mantle Cell Lymphoma](https://onco.cc/trials/nct06084936/), [A Study to Investigate the Efficacy of Zanubrutinib Plus Rituximab Compared With Bendamustine Plus Rituximab in Adults With Previously Untreated Mantl](https://onco.cc/trials/nct04002297/), [DALY II USA/ MB-CART2019.1 for DLBCL](https://onco.cc/trials/nct04792489/), [Efficacy and Safety of MB-CART2019.1 vs. SoC in Lymphoma Patients](https://onco.cc/trials/nct04844866/), [ENRICH](https://onco.cc/trials/enrich/), [GALLIUM](https://onco.cc/trials/gallium/), [Mosunetuzumab with lenalidomide in relapsed marginal zone lymphoma](https://onco.cc/trials/mosun-len-mzl/), [MURANO](https://onco.cc/trials/murano/), [Phase 2 Study Evaluating Autologous CD30.CAR-T Cells in Patients With Relapsed/Refractory Hodgkin Lymphoma (CHARIOT)](https://onco.cc/trials/nct04268706/), [Randomized Phase II Trial of Rituximab With Either Pentostatin or Bendamustine for Multiply Relapsed or Refractory Hairy Cell Leukemia](https://onco.cc/trials/nct01059786/), [RELEVANCE](https://onco.cc/trials/relevance/), [SHINE](https://onco.cc/trials/shine/), [Study to Assess the Efficacy and Safety of Ublituximab + Umbralisib With or Without Bendamustine and Umbralisib Alone in Patients With Previously Treated Non-Hodgkins Lymphoma](https://onco.cc/trials/nct02793583/)
- key papers: [Acalabrutinib plus bendamustine-rituximab in untreated mantle cell lymphoma](https://onco.cc/key-papers/paper-echo-acalabrutinib-bendamustine-rituximab-mantle-cell-jco-2025/), [Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial](https://onco.cc/key-papers/paper-rummel-lancet/), [Ibrutinib and rituximab versus immunochemotherapy in patients with previously untreated mantle cell lymphoma (ENRICH): a randomised, open-label, phase 2/3 superiority trial](https://onco.cc/key-papers/paper-enrich-ibrutinib-rituximab-mantle-cell-lancet-2025/), [Ibrutinib plus bendamustine and rituximab in untreated mantle-cell lymphoma](https://onco.cc/key-papers/paper-shine-ibrutinib-bendamustine-rituximab-mantle-cell-nejm-2022/), [MURANO: two years of venetoclax plus rituximab versus chemo-immunotherapy in relapsed CLL](https://onco.cc/key-papers/paper-murano-venetoclax-rituximab-nejm-2018/)
- terms: [Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination](https://onco.cc/terms/lymphoma-tx-pjp-and-infection-prophylaxis/), [Lymphodepletion before CAR-T](https://onco.cc/terms/lymphodepletion/), [MYD88 L265P and CXCR4 mutations](https://onco.cc/terms/myd88-l265p/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/), [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/)
- roadmaps: [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/)

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