Presentation and management of the delayed type of hypersensitivity reaction with bendamustine

Abstract

Bendamustine, an alkylating agent with cytotoxic properties, has been increasingly employed in the treatment of chronic lymphocytic leukemia (CLL) either as a single agent or combination with rituximab. Although rarely reported, they can potentially cause hypersensitivity reactions with serious consequences. The objective of the case report was to offer a safe and effective bendamustine desensitization protocol to patients with a hypersensitivity reaction to this drug. We report a case of a patient with a CLL who developed a type IV hypersensitivity reaction to bendamustine and who was successfully treated by drug desensitization. A 51-year-old man with CLL was started on chemotherapy with bendamustin-rituximab developed a type IV hypersensitivity reaction 3 days later. A desensitization protocol was developed for the second cycle of bendamustine. This protocol was well tolerated, and no hypersensitivity reaction was observed. The desensitization protocol allowed us to continue the treatment, and to achieve a favorable response of the CLL. Patients with a hypersensitivity reaction to bendamustine can safely receive bendamustine by our rapid desensitization protocol.

Risk Factors for Skin Toxicities Associated with Bendamustine-Based Chemotherapy in Patients with Non-Hodgkin Lymphoma

“…Concerning continuous treatment with bendamustine, meanwhile, two bendamustine desensitization protocols have been proposed for patients who develop hypersensitivity reactions, including rash, after BR therapy. 25,26) These treatments were successfully completed without developing a rash, and the symptoms were well-managed by antihistamines and corticosteroids. Bendamustine-based chemotherapy is an outpatient chemotherapy regimen, and so the administration of premedication with antihistamines such as diphenhydramine may be acceptable choice for prophylaxis.…”

Bendamustine-induced rash is associated with a favorable prognosis in patients with indolent B-cell lymphoma

“…Outcomes of patients with mantle cell lymphoma relative to bendamustine-induced rash (A: progression-free survival, B: overall survival) reaction or anaphylaxis. 12 Delayed hypersensitivity reactions were noted in 6 patients in this study. Bellón proposed T cell-mediated drug-specific immune response due to delayed type IV hypersensitivity reaction.…”