Safe and effective treatment of aggressive non-hodgkin lymphoma with rituximab and bendamustine in patients with severe liver impairment.

Rituximab (Rituxan, Genentech/Biogen Idec Pharmaceuticals) in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is currently the most widely used first-line therapy for aggressive B-cell lymphomas.1 However, many patients, including those with organ dysfunction, may not tolerate the toxicities associated with this regimen. Recent data from the phase III Study Group Indolent Lymphomas (StiL) non-Hodgkin lymphoma (NHL)-1 trial suggested that bendamustine (Treanda, Cephalon) plus rituximab was superior in effectiveness and tolerability compared to R-CHOP in the treatment of indolent and mantle cell lymphomas.2 Small studies have indicated the effective use of bendamustine alone or in combination in the treatment of aggressive B-cell lymphomas as well.3-5 Here we report the safe and effective use of bendamustine plus rituximab in 2 patients: one patient with transformation from follicular lymphoma to diffuse large B-cell lymphoma (DLBCL), and another patient with de novo DLBCL. Both patients had severe liver impairment. They tolerated treatment without adverse effects and had a dramatic initial response.