Bendamustine (Levact) | Cancer Research UK
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What bendamustine is

Bendamustine is a type of chemotherapy drug. It is also called Levact. It is an alkylating agent. These drugs work by interfering with the DNA in cancer cells. The cells can’t divide into 2 new cells so the cancer can’t grow.

It is a treatment for

  • Chronic lymphocytic leukaemia for people who can’t have fludarabine
  • Non Hodgkin’s lymphoma for people who have already had rituximab
  • Myeloma for people who can’t have high dose chemotherapy with a stem cell transplant and are unable to have thalidomide or bortezomib

Research is also looking at bendamustine as a treatment for other types of cancer.


How you have bendamustine

Bendamustine is a clear liquid. You have it as a drip (infusion) into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have chemotherapy as a course of several cycles of treatment. How you have it depends on the type of cancer you have.

For chronic lymphocytic leukaemia each cycle of treatment lasts for 4 weeks. You have bendamustine on the 1st and 2nd day of the cycle of treatment. And then you have a break for 26 days before the cycle starts again.

For non Hodgkin's lymphoma each cycle of treatment lasts for 3 weeks. You have the drug by drip on the 1st and 2nd day of treatment. You then have a break for 19 days before the cycle starts again.

For myeloma each cycle lasts for 4 weeks. You have bendamustine on the 1st and 2nd day of the cycle of treatment. And you have the steroid, prednisolone either as an injection into your bloodstream or as a tablet for the first 4 days. You then have no treatment for 26 days before the cycle starts again.


Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.


About side effects

We've listed the side effects associated with bendamustine below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

The side effects may be different if you are having bendamustine with other drugs.

Tell your doctor or nurse straight away if any of the side effects get severe.


Common side effects

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – this can cause nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Feeling or being sick in about 7 in 10 people (70%) – this is usually mild
  • A skin rash,which may be itchy
  • Tiredness during and after treatment in nearly 4 out of 10 people (40%)
  • Loss of fertility – you may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment
  • A sore mouth

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Hair loss or thinning – hair usually just thins rather than falling out completely
  • Difficulty sleeping
  • Change in heart rhythm (palpitations) and chest pain – tell your doctor if this happens
  • Your blood pressure may be higher or lower than normal – your doctor or nurse will check this regularly
  • Diarrhoea occurs in just under half the people who have bendamustine
  • Constipation
  • Liver changes – you are unlikely to notice any symptoms and your liver function will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your liver is working
  • Allergic reaction during the infusion – this nearly always happens in the first 10 minutes. If you are going to have a reaction, it is most likely the first or second time you have the drug. Your chemotherapy nurse will monitor you closely
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Inflammation around the drip site when having bendamustine – if you notice any signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately
  • Loss of appetite
  • Kidney changes that are unlikely to cause symptoms – the kidneys will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your kidneys are working
  • High uric acid levels in the blood due to the breakdown of tumour cells (tumour lysis syndrome) – you will have regular blood tests to check your uric acid levels and may have a tablet called allopurinol to take. Drinking plenty of fluids helps to flush out the excess uric acid.
  • Changes in lung tissue that may cause breathlessness or a cough

Rare side effects

Fewer than 1 in 100 people have these effects.

  • Taste changes
  • Bleeding in the food pipe – let your doctor or nurse know straight away if you have any blood in your spit
  • Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment. Some people may have permanent numbness

Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not breastfeed during this treatment because the drug may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


More information about bendamustine

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 24 January 2014