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Generic Name: Bendamustine hydrochloride
Trade Name(s): Treanda^®

Treanda^® is the trade name of the chemotherapy drug bendamustine . In some cases, health care professionals may use the trade name Treanda ^® when referring to the generic drug name bendamustine.

Drug Type:

Treanda is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Treanda is classified as an "alkylating agent".

What Treanda Is Used For:

• Treanda is used for treatment of chronic lymphocytic leukemia (CLL).
• Treanda is used for the treatment of patients with indolent B-cell non-Hodgkin's lymphoma.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Treanda Is Given:

• As an injection into the vein (intravenous, IV).
• There is no pill form of Treanda.
• The amount of Treanda that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of Treanda:

• Most people will not experience all of the Treanda side effects listed.
• Treanda side effects are often predictable in terms of their onset, duration, and severity.
• Treanda side effects are almost always reversible and will go away after therapy is complete.
• Treanda side effects may be quite manageable. There are many options to minimize or prevent the side effects of bendamustine.

The following Treanda side effects are common (occurring in greater than 30%) for patients taking Treanda:

• Low blood counts.  Your white and red blood cells and platelets may temporarily decrease.  This can put you at increased risk for infection, anemia and/or bleeding.

Nadir  Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience lowest blood counts. 

Nadir: 14 to 21 days
Recovery: 28 days

• Increase in bilirubin levels

These are less common side effects (occurring in about 10-29%) for patients receiving Treanda: 

• Infusion reaction (chills, fever, itching, rash) may require pre-medications,
• Fever 
• Nausea 
• Vomiting
• fatigue 
• Diarrhea
• Rash

Rare but serious complications of Treanda therapy.

• Tumor lysis syndrome may occur as a result of leukemia treatment including treatment with bendamustine. Tumor lysis syndrome occurs when large amounts of cancerous cells are rapidly killed by the therapy. These cells release uric acid, potassium and phosphorus into the blood stream. Tumor lysis syndrome can lead to kidney failure. Tumor lysis syndrome usually occurs within 24 – 48 hours of therapy. Care must be taken to prevent the development of tumor lysis syndrome. Your health care provider will prescribe plenty of fluids to keep you hydrated. You may be given a drug called allopurinol that blocks uric acid production. In some cases, your health care provider may prescribe other measures to lower your white blood count before therapy. Let your health care provider know immediately if you are unable to urinate. Your health care provider will monitor your progress carefully during therapy.
• Infertility (loss of fertility). Meaning, your ability to conceive or father a child may be affected by Treanda. Discuss this issue with your health care provider.

This list includes common and less common side effects for those taking Treanda. Treanda side effects that are very rare -- occurring in less than about 10 percent of patients -- are not all listed here. Always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your doctor or health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency. Contact your doctor or health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Unusual  bleeding or  bruising
• Black or tarry stools or blood in your stools
• Blood in your urine
• Pain or burning with urination
• Extreme fatigue (unable to carry on self-care activities)
• Severe or worsening Rash or itching
• Yellowing of the skin or eyes.
• Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.

Always inform your doctor or health care provider if you experience any unusual symptoms.

Precautions:

• Before starting bendamustine treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). While taking bendamustine do not take aspirin or products containing aspirin unless your doctor specifically permits this.
• While taking bendamustine, do not receive any kind of immunization or vaccination without your doctor’s approval.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (bendamustine may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Use contraceptives and do not conceive a child (get pregnant) while taking Treanda. Barrier methods of contraception such as condoms are recommended.
• Do not breast feed while taking Treanda.

Self-Care Tips:

• While taking Treanda, try to drink at least two to three quarts of fluid every 24 hours, (particularly the 24 hours before and 48 hours following the infusion) unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury. 
• To help treat/prevent mouth sores while taking bendamustine, use a soft toothbrush, and rinse three times a day with 1 teaspoon of baking soda mixed with 8 ounces of water.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals while taking Treanda.
• Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
• You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely while you are taking Treanda. You should discuss this with your doctor.
• Get plenty of rest.
• Maintain good nutrition while being treated with Treanda.
• If you experience symptoms or side effects while being treated with Treanda, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your doctor while you are taking Treanda to monitor side effects and check your response to therapy. Periodic blood work will be obtained to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver).

How Treanda Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Treanda is classified as an alkylating agent.  Alkylating agents are most active in the resting phase of the cell-cycle.  There are several types of alkylating agents. Treanda is a nitrogen mustard derivative and is active against resting as well as dividing cells.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this web site is meant to be helpful and educational, but is not a substitute for medical advice. 

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org