Encephalopathy after Bendamustine Treatment: A Rare Side Effect?
KeywordsFollicular lymphoma, bendamustine, rituximab, neurotoxicity, encephalopathy
Bendamustine is a chemotherapeutic drug associated with frequent haematological and gastrointestinal adverse effects and, more rarely, neurological toxicity.
We present the case of a 79-year-old man with follicular lymphoma, grade 2, Ann-Arbor stage IV-A, FLIPI 4, high risk, with bulky disease and vital organ compression, treated with R-CHOP and then rituximab-bendamustine, who developed encephalopathy approximately 2 months after the last cycle. After ruling out other possible aetiologies, we assumed the patient’s encephalopathy was due to a delayed bendamustine side effect, possibly aggravated by the concomitant administration of rituximab.
The authors hope to alert clinicians to this rare adverse effect, its difficult identification and the need to rule out other aetiologies.
Munakata W, Tobinai K. The discovery and the development of bendamustine for the treatment of non-Hodgkin lymphoma. Expert Opin Drug Discov2016;11(11):1123–1130.
Vidal L, Gurion R, Shargian L, Dreyling M, Gafter-Gvili A. Bendamustine for patients with indolent B cell lymphoproliferative malignancies including chronic lymphocytic leukaemia – an update meta-analysis. Br J Haematol 2019;186(2):234–242.
Cheson BD, Brugger W, Damaj G, Dreyling M, Kahl B, Kimby E, et al. Optimal use of bendamustine in hematologic disorders: Treatment recommendations from an international consensus panel – an update. Leuk Lymphoma 2016;57(4):766–82.
Cheson BD, Kroll ML. Bendamustine induced neurotoxicity. Clin Adv Hematol Oncol 2009;7(11):743–746.
Alhafez A, Aljitawi OS, Lin TL, Ganguly S, Abhyankar S, McGuirk JP. Bendamustine associated with irreversible ascending paralysis. Case Rep Hematol 2013;2013:931519.
Stone JB, De Angelis LM. Cancer treatment-induced neurotoxicity: a focus on newer treatments. Nat Rev Clin Oncol 2016;13(2):92–105.
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