{"entity":{"id":"bendamustine","kind":"drug","name":"Bendamustine","aka":[],"tldr":"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).","status":"approved","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Bendamustine","links":[{"label":"StiL NHL1 (Lancet 2013)","url":"https://doi.org/10.1016/S0140-6736(12)61763-2"},{"label":"Label (DailyMed)","url":"https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=bendamustine"}],"tags":["gap-fill","generic"],"related":[],"cancers":["follicular-lymphoma","mantle-cell-lymphoma","waldenstrom","cll"],"sections":[],"technologies":["cytotoxic-chemotherapy"],"targets":[],"drugs":[],"companies":["symbio-pharmaceuticals","mundipharma"],"institutions":[],"pathways":[],"terms":[],"trials":["nct04002297","nct06363994","nct04792489","nct07189065","nct04844866","nct04268706","nct05624554","nct06084936","nct06846671","nct05023980","nct02970318","nct06522737","nct06970743","nct02972840"],"people":[],"bottlenecks":[],"keyPapers":["paper-rummel-lancet"],"journals":[],"dependsOn":[],"notes":[],"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":[{"region":"US","year":2008,"indication":"CLL; indolent B-cell NHL progressed within 6 months of rituximab"},{"region":"EU","year":2010,"indication":"CLL, indolent NHL, multiple myeloma (national approvals)"}],"mechanismSteps":[],"toxicity":[],"access":[],"regulatoryEvents":[]},"route":"/drugs/bendamustine/","neighbours":{"cancer":[{"id":"cll","kind":"cancer","name":"Chronic lymphocytic leukaemia","route":"/cancers/cll/"},{"id":"cll-treatment-naive","kind":"cancer","name":"Chronic lymphocytic leukaemia, first treatment","route":"/cancers/cll-treatment-naive/"},{"id":"dlbcl","kind":"cancer","name":"Diffuse large B-cell lymphoma","route":"/cancers/dlbcl/"},{"id":"malt-lymphoma","kind":"cancer","name":"Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)","route":"/cancers/malt-lymphoma/"},{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"},{"id":"gastric-malt-lymphoma","kind":"cancer","name":"Gastric MALT lymphoma","route":"/cancers/gastric-malt-lymphoma/"},{"id":"mantle-cell-lymphoma","kind":"cancer","name":"Mantle cell lymphoma","route":"/cancers/mantle-cell-lymphoma/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"nodal-marginal-zone-lymphoma","kind":"cancer","name":"Nodal marginal zone lymphoma","route":"/cancers/nodal-marginal-zone-lymphoma/"},{"id":"nodular-lymphocyte-predominant-hodgkin-lymphoma","kind":"cancer","name":"Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)","route":"/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/"},{"id":"non-hodgkin-lymphoma","kind":"cancer","name":"Non-Hodgkin lymphoma (all types)","route":"/cancers/non-hodgkin-lymphoma/"},{"id":"ocular-adnexal-malt-lymphoma","kind":"cancer","name":"Ocular adnexal MALT lymphoma","route":"/cancers/ocular-adnexal-malt-lymphoma/"},{"id":"peripheral-t-cell-lymphoma","kind":"cancer","name":"Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)","route":"/cancers/peripheral-t-cell-lymphoma/"},{"id":"relapsed-refractory-hodgkin-lymphoma","kind":"cancer","name":"Relapsed and refractory classical Hodgkin lymphoma","route":"/cancers/relapsed-refractory-hodgkin-lymphoma/"},{"id":"splenic-b-cell-lymphoma-leukaemia-prominent-nucleoli","kind":"cancer","name":"Splenic B-cell lymphoma/leukaemia with prominent nucleoli (formerly B-cell prolymphocytic leukaemia and hairy cell leukaemia variant)","route":"/cancers/splenic-b-cell-lymphoma-leukaemia-prominent-nucleoli/"},{"id":"splenic-marginal-zone-lymphoma","kind":"cancer","name":"Splenic marginal zone lymphoma","route":"/cancers/splenic-marginal-zone-lymphoma/"},{"id":"waldenstrom","kind":"cancer","name":"Waldenström macroglobulinaemia","route":"/cancers/waldenstrom/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"}],"company":[{"id":"lupeng-pharmaceuticals","kind":"company","name":"Lupeng Pharmaceuticals","route":"/companies/lupeng-pharmaceuticals/"},{"id":"mundipharma","kind":"company","name":"Mundipharma","route":"/companies/mundipharma/"},{"id":"symbio-pharmaceuticals","kind":"company","name":"SymBio Pharmaceuticals","route":"/companies/symbio-pharmaceuticals/"}],"trial":[{"id":"nct06363994","kind":"trial","name":"A Global Phase 3 Study of Orelabrutinib+BR Vs.BR in Pts with TN MCL","route":"/trials/nct06363994/"},{"id":"nct02970318","kind":"trial","name":"A Study of Acalabrutinib vs Investigator's Choice of Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in R/R CLL","route":"/trials/nct02970318/"},{"id":"nct06970743","kind":"trial","name":"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","route":"/trials/nct06970743/"},{"id":"nct02972840","kind":"trial","name":"A Study of BR Alone Versus in Combination With Acalabrutinib in Subjects With Previously Untreated MCL","route":"/trials/nct02972840/"},{"id":"nct06522737","kind":"trial","name":"A Study of Duvelisib Versus Gemcitabine or Bendamustine in Participants With Relapsed/Refractory Nodal T Cell Lymphoma With T Follicular Helper (TFH) Phenotype","route":"/trials/nct06522737/"},{"id":"nct05624554","kind":"trial","name":"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)","route":"/trials/nct05624554/"},{"id":"nct05023980","kind":"trial","name":"A Study of Pirtobrutinib (LOXO-305) Versus Bendamustine Plus Rituximab (BR) in Untreated Patients With Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)","route":"/trials/nct05023980/"},{"id":"nct07189065","kind":"trial","name":"A Study of Rocbrutinib in Participants With Relapse or Refractory Non-GCB Diffuse Large B-Cell Lymphoma","route":"/trials/nct07189065/"},{"id":"nct06846671","kind":"trial","name":"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","route":"/trials/nct06846671/"},{"id":"nct06084936","kind":"trial","name":"A Study to Evaluate Glofitamab as a Single Agent vs. Investigator's Choice in Participants With Relapsed/Refractory Mantle Cell Lymphoma","route":"/trials/nct06084936/"},{"id":"nct04002297","kind":"trial","name":"A Study to Investigate the Efficacy of Zanubrutinib Plus Rituximab Compared With Bendamustine Plus Rituximab in Adults With Previously Untreated Mantl","route":"/trials/nct04002297/"},{"id":"nct04792489","kind":"trial","name":"DALY II USA/ MB-CART2019.1 for DLBCL","route":"/trials/nct04792489/"},{"id":"nct04844866","kind":"trial","name":"Efficacy and Safety of MB-CART2019.1 vs. SoC in Lymphoma Patients","route":"/trials/nct04844866/"},{"id":"enrich","kind":"trial","name":"ENRICH","route":"/trials/enrich/"},{"id":"gallium","kind":"trial","name":"GALLIUM","route":"/trials/gallium/"},{"id":"mosun-len-mzl","kind":"trial","name":"Mosunetuzumab with lenalidomide in relapsed marginal zone lymphoma","route":"/trials/mosun-len-mzl/"},{"id":"murano","kind":"trial","name":"MURANO","route":"/trials/murano/"},{"id":"nct04268706","kind":"trial","name":"Phase 2 Study Evaluating Autologous CD30.CAR-T Cells in Patients With Relapsed/Refractory Hodgkin Lymphoma (CHARIOT)","route":"/trials/nct04268706/"},{"id":"nct01059786","kind":"trial","name":"Randomized Phase II Trial of Rituximab With Either Pentostatin or Bendamustine for Multiply Relapsed or Refractory Hairy Cell Leukemia","route":"/trials/nct01059786/"},{"id":"relevance","kind":"trial","name":"RELEVANCE","route":"/trials/relevance/"},{"id":"shine","kind":"trial","name":"SHINE","route":"/trials/shine/"},{"id":"nct02793583","kind":"trial","name":"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","route":"/trials/nct02793583/"}],"paper":[{"id":"paper-echo-acalabrutinib-bendamustine-rituximab-mantle-cell-jco-2025","kind":"paper","name":"Acalabrutinib plus bendamustine-rituximab in untreated mantle cell lymphoma","route":"/key-papers/paper-echo-acalabrutinib-bendamustine-rituximab-mantle-cell-jco-2025/"},{"id":"paper-rummel-lancet","kind":"paper","name":"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","route":"/key-papers/paper-rummel-lancet/"},{"id":"paper-enrich-ibrutinib-rituximab-mantle-cell-lancet-2025","kind":"paper","name":"Ibrutinib and rituximab versus immunochemotherapy in patients with previously untreated mantle cell lymphoma (ENRICH): a randomised, open-label, phase 2/3 superiority trial","route":"/key-papers/paper-enrich-ibrutinib-rituximab-mantle-cell-lancet-2025/"},{"id":"paper-shine-ibrutinib-bendamustine-rituximab-mantle-cell-nejm-2022","kind":"paper","name":"Ibrutinib plus bendamustine and rituximab in untreated mantle-cell lymphoma","route":"/key-papers/paper-shine-ibrutinib-bendamustine-rituximab-mantle-cell-nejm-2022/"},{"id":"paper-murano-venetoclax-rituximab-nejm-2018","kind":"paper","name":"MURANO: two years of venetoclax plus rituximab versus chemo-immunotherapy in relapsed CLL","route":"/key-papers/paper-murano-venetoclax-rituximab-nejm-2018/"}],"term":[{"id":"lymphoma-tx-pjp-and-infection-prophylaxis","kind":"term","name":"Infection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination","route":"/terms/lymphoma-tx-pjp-and-infection-prophylaxis/"},{"id":"lymphodepletion","kind":"term","name":"Lymphodepletion before CAR-T","route":"/terms/lymphodepletion/"},{"id":"myd88-l265p","kind":"term","name":"MYD88 L265P and CXCR4 mutations","route":"/terms/myd88-l265p/"},{"id":"r-chop","kind":"term","name":"R-CHOP (lymphoma chemoimmunotherapy)","route":"/terms/r-chop/"},{"id":"lymphoma-tx-regimen-alphabet","kind":"term","name":"The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest","route":"/terms/lymphoma-tx-regimen-alphabet/"}],"roadmap":[{"id":"lymphoma-roadmap","kind":"roadmap","name":"Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted 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