An old drug with a new future: bendamustine in multiple myeloma.
BACKGROUND
Bendamustine is a unique bifunctional alkylating agent with promising activity in multiple myeloma (MM). It is currently licensed in Europe for use as frontline treatment with prednisolone for patients with MM who are unsuitable for transplantation and who are contraindicated for thalidomide and bortezomib therapy.


METHODS
Studies evaluating the safety and efficacy of bendamustine administered alone or in combination in both the upfront and relapse settings of MM patients, including those with renal insufficiency, were reviewed. The use of bendamustine as conditioning for autologous stem-cell transplantation and the possibility of stem-cell mobilization after bendamustine therapy are discussed.


CONCLUSIONS
Bendamustine seems to be efficacious either in monotherapy or in combination with other drugs in previously treated or untreated patients. This is due to its unique mechanism of action including its ability to activate apoptosis and inhibit mitotic checkpoints, making it potentially more effective than other alkylating agents. Moreover, it has an acceptable toxicity profile and is suitable for patients with renal impairment. Finally, this drug does not seem to compromise the possibility of achieving a stem-cell mobilization. Nonetheless, data from Phase III studies demonstrating its effectiveness in terms of overall survival are not yet available.
Unitá Operativa Complessa di Ematologia, Dipartimento Oncoematologico, Azienda Ospedaliera di Cosenza , Viale della Repubblica, 87100 Cosenza , Italy +39 0 984 681329 ; +39 0 984 791751 ; massim.gentile@tiscali.it.
Massimo
M
Gentile
Anna Grazia
AG
Recchia
Carla
C
Mazzone
Ernesto
E
Vigna
Massimo
M
Martino
Lucio
L
Morabito
Eugenio
E
Lucia
Sabrina
S
Bossio
Laura
L
De Stefano
Teresa
T
Granata
Angela
A
Palummo
Fortunato
F
Morabito
D000477:Alkylating Agents / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride; D006801:Humans; D009101:Multiple Myeloma / Q000188:drug therapy*; D009588:Nitrogen Mustard Compounds / Q000627:therapeutic use*; D016896:Treatment Outcome
D000477:Alkylating Agents; D009588:Nitrogen Mustard Compounds; D000069461:Bendamustine Hydrochloride