Bendamustine (Levact)

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 then divide into 2 new cells and 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.

You have bendamustine 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 first and second day of the cycle of treatment. And then 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 first and second 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 first and second 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.

The side effects associated with bendamustine are listed below. You can use the underlined links to find out more about each side effect. For general information, see our cancer drug side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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, sore throat, pain passing urine or feel cold and shivery
• 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)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• 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%)
• Bendamustine may have a harmful effect on a baby developing in the womb. You should not get pregnant while taking this drug. Men should not father a child while having this treatment or for 6 months afterwards. Discuss contraception with your doctor or nurse before you start your treatment if there is any possibility that you or your partner could become pregnant
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• It is not advisable to breastfeed while having this treatment because the drug may come through in the breast milk

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
• A sore mouth
• 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

The side effects above 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

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

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

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.