BR

What this treatment is and how it works

BR combines bendamustine and rituximab for selected B-cell lymphomas and some CLL settings. Treatment choice depends on the disease and available alternatives. Using medicines with different actions helps attack cancer cells in more than one way. Healthy cells can also be affected, causing side effects.

When it may be used

Your team may use this treatment in the following settings: Selected B-cell lymphomas and selected CLL settings. The choice depends on the exact diagnosis, stage, previous treatment, health and treatment aim. Treatment may aim to cure cancer, lower the risk of recurrence, or control cancer and symptoms, depending on the setting.

A listed use is not a claim that every brand is licensed for that use in every country. Your oncologist will explain why this treatment is appropriate for you.

Before treatment

Before starting, tell the team about previous cancer treatment, allergies, infection symptoms, heart, lung, kidney or liver disease, hearing or nerve problems, diabetes and all medicines you take. Discuss pregnancy, contraception and fertility. Ask for a written treatment calendar, supportive-medicine instructions and a 24-hour oncology contact number. Baseline blood tests usually include a full blood count and kidney and liver function; additional tests depend on the medicine and your health. Before chemotherapy that reaches the whole body, the team should check for current or past hepatitis B infection. If a test is positive, extra monitoring or antiviral treatment may be needed to prevent the virus becoming active again. The team will coordinate testing and treatment; do not delay urgent cancer treatment yourself.

How treatment is given and the schedule

Rituximab premedication and anti-sickness medicines are given. After a full intravenous rituximab dose has been tolerated, some plans use a different rituximab formulation injected under the skin. Your team will confirm the formulation and schedule. Antiviral or Pneumocystis prevention and tumour lysis prevention may be prescribed.

• Rituximab is an antibody that attaches to a protein called CD20 on certain B cells, a type of white blood cell.

The dose is calculated for your treatment and health. Rest periods, delays or dose changes may be needed. Do not change doses or treatment dates yourself, except to follow specific instructions to stop a medicine and seek help for warning symptoms. The team will give you a revised plan when needed.

During an infusion, tell the nurse immediately about pain, burning, swelling or leaking around the cannula or line. Do not massage the area or apply heat or ice unless the team instructs you.

Tests and monitoring during treatment

Blood counts, kidney and liver function, hepatitis B status and infection risk are assessed. Immune suppression can continue for months. New neurological symptoms require assessment for rare infections such as progressive multifocal leukoencephalopathy (PML), which affects the brain.

At each review, describe symptoms since the previous dose, including problems that have already settled. Blood tests can detect effects before you feel them. Your team may delay, reduce, omit or stop a medicine if results or symptoms make this necessary. The decision depends on the exact protocol; a normal result does not make new symptoms safe to ignore.

Side effects: what to expect

Side-effect rates depend on the exact protocol, doses and other treatments. Frequencies from individual-drug labels cannot simply be added together or treated as regimen rates. The groups below describe the expected clinical pattern without assigning unsupported percentages.

You are unlikely to have all of these effects. This is not an exhaustive list. Tell the team about any new or troublesome symptom, including one not mentioned here.

Common or more frequent side effects

Other reported side effects (frequency varies)

These effects may be common in some treatment settings, less common in others, or have no reliable frequency estimate. Their position here does not mean they are necessarily less frequent or less serious.

Infusion reactions, rash, constipation, diarrhoea and liver-test changes can occur. Hair thinning is possible but varies.

Report these at review, or sooner if worsening. Use the urgent guidance for symptoms that affect breathing, drinking, urination, walking, consciousness or bleeding.

Important serious side effects, including rare effects

Serious does not always mean rare. Where reliable incidence is unavailable, no numerical frequency is assigned. The action to take matters even when the likelihood is uncertain.

Severe infusion or allergic reaction

Itching, flushing, wheeze, dizziness, throat tightness or facial swelling can start during an infusion or later. Tell the nurse immediately. Severe breathing difficulty, collapse or sudden face/throat swelling is an emergency.

Infections during prolonged immune suppression

Unusual infections can occur during treatment and afterwards. Report fever, persistent cough, breathlessness, shingles-like blisters or unexplained deterioration promptly. Continue preventive medicines for the full prescribed period.

Hepatitis B reactivation

An old hepatitis B infection can become active again during immune-suppressing treatment. Screening, antiviral prevention and follow-up reduce risk. Report jaundice, dark urine, abdominal pain or unusual fatigue, including after chemotherapy ends.

A rare serious brain infection (PML)

Progressive multifocal leukoencephalopathy is a rare infection linked to impaired immunity. New or worsening problems with speech, vision, balance, memory, behaviour or one-sided weakness need urgent assessment. Sudden stroke-like symptoms are an emergency.

Severe skin reaction

A spreading painful rash, blisters, peeling skin, or sores in the mouth, eyes or genital area needs urgent medical assessment. Severe reactions may require treatment to be stopped by the team.

Tumour lysis syndrome

When many cancer cells break down quickly, blood salts and kidney function can change dangerously. Preventive fluids or medicines and blood tests may be needed. Reduced urine, severe cramps, palpitations, vomiting or confusion requires urgent assessment.

Practical advice for this treatment

Continue infection-prevention medicines until the team tells you to stop. Report any rash promptly, especially blisters or sores in the mouth or eyes. Ask about transfusion precautions and an irradiated-blood alert card under local policy.

Medicines, interactions and vaccinations

Give the oncology pharmacist a complete list of prescription medicines, over-the-counter products, vitamins, herbal and Ayurvedic remedies and supplements. Ask before starting anything new. Do not stop prescribed medicines, including anticoagulants or infection-prevention medicines, without a coordinated plan. Live vaccines are generally unsuitable while immunity is suppressed; discuss vaccine type and timing with the team. Non-live vaccines may be offered, although protection can be reduced. Follow any specific stop-and-call instructions for the cancer medicine on this page or in your written treatment plan.

• Bendamustine: The pharmacist should review other immune-suppressing medicines and drugs affecting liver enzymes. Allopurinol may be used for tumour lysis prevention but can increase concern about severe skin reactions; report any rash promptly and let the team choose the prevention plan.

Rituximab adds prolonged infection and hepatitis B reactivation risks. Follow the team’s instructions about antiviral medicines, vaccines and any temporary change to blood-pressure tablets.

Pregnancy, fertility and breastfeeding

Chemotherapy can harm a developing baby and may affect fertility temporarily or permanently. Discuss sperm, egg or embryo storage before treatment when feasible. If you could become pregnant, or your partner could become pregnant, use effective contraception during treatment and for the drug-specific period afterwards. Ask for a written end date based on every medicine in your plan: the required period differs by product and can extend for months. Periods stopping does not guarantee infertility. Tell the team immediately about a suspected pregnancy. Do not breastfeed during treatment; restart only after the team confirms the interval for the exact medicine and formulation.

Everyday life

Gentle activity, regular meals and rest can help you cope. Prepare food hygienically and drink according to your individual fluid plan. Avoid smoking; ask whether alcohol is safe with your exact treatment and other medicines. Plan work, travel and driving around symptoms and monitoring visits. Do not drive if dizzy, sleepy, weak, visually affected or impaired by neuropathy. You can usually be close to family and friends: chemotherapy does not make you radioactive. Follow the unit’s instructions for handling urine, vomit, laundry and sexual precautions for the period it specifies.

When to contact the oncology team

Contact the oncology team the same day for persistent vomiting or diarrhoea, difficulty drinking, reduced urine, mouth pain affecting eating, new cough, jaundice, a painful or spreading rash, unusual bruising, worsening constipation or new nerve symptoms. Use the more urgent instructions for the particular symptom when given above. If the team cannot be reached and you are unwell, seek urgent medical care.

Write down your hospital’s daytime and out-of-hours numbers before treatment. CTI’s general contact details do not replace the emergency number provided by your treating hospital.

After treatment

Keep the planned blood tests and follow-up appointments after the last dose. Blood counts and immunity may take time to recover, and some effects can start or persist later. Contact the team about symptoms rather than waiting for a routine visit. Keep a treatment summary, including drug names, dates and any serious reactions, for future doctors. Response may be assessed with examination, scans or blood or marrow tests, depending on the cancer.

Words you may hear

CLL

Chronic lymphocytic leukaemia, a cancer involving certain white blood cells.

Frequently asked questions

Individual medicine guides

• Bendamustine