What question did this study set out to answer?

The study aims to assess the impact of reduced bendamustine dosage on efficacy and safety in elderly patients with follicular lymphoma.

February 8, 2026Open Access

Balancing safety and efficacy of Bendamustine plus anti CD20 regimens in elderly patients (> 70 y) with follicular lymphoma: a tertiary academic center experience

MDMattia D’AntigaUniversity of Padua NDNicolò DanesinUniversity of Padua GLGiovanni LeoneUniversity of Padua

Key Points

The study aims to assess the impact of reduced bendamustine dosage on efficacy and safety in elderly patients with follicular lymphoma.
Retrospective evaluation of elderly patients with follicular lymphoma receiving bendamustine combined with either rituximab or obinutuzumab.
Patients categorized into reduced intensity (Low-DDI) and full intensity (High-DDI) groups based on delivery dose intensity.
Primary outcomes included progression-free survival and overall survival, while secondary outcomes focused on response rates and toxicities.
Median overall survival was 31.5 months for low-DDI vs. 65.0 months for high-DDI, not statistically significant (p 0.238).
Median progression-free survival was 20.5 months for low-DDI vs. 28.0 months for high-DDI (p = 0.081).
Overall response rates were 78.9% for low-DDI vs. 100% for high-DDI (p = 0.105), and complete response rates 36.8% vs. 72.2% (p = 0.067).
Toxicity analysis showed no significant differences in grade ≥ 3 events or hospitalization rates.

Abstract

Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma (NHL) in Western countries, with 65 beign the average age at diagnosis 1. First-line treatment regimens combining Bendamustine (B) with Rituximab (R) or Obinutuzumab (G) have shown favorable outcomes in pivotal trials 2-4. Their efficacy and safety in patients aged 70 or older, who often receive reduced doses, remain unclear. This retrospective study evaluated the impact of reduced Bendamustine Delivered Dose Intensity DDI, calculated as the total amount of Bendamustine (mg/m²) administered divided by the time taken to complete the regimen, with imputation for missed cycles on outcomes and toxicities in FL patients (grade 1-3a) aged 70 or older treated with B-R or B-G between January 2014 and December 2023 at our center. Patients were categorized in reduced intensity (Low-DDI) and full intensity (High-DDI), based on the median DDI of the cohort. Efficacy was evaluated in the low DDI vs. high DDI setting, while toxicity outcomes were evaluated in the elderly (age ≥ 70 < 75 years) vs. very elderly (age ≥ 75yrs) population. Primary outcomes included progression-free survival (PFS) and overall survival (OS). Secondary outcomes included response rates, Progression of disease at 24 months (POD24) and toxicities. Among 139 FL patients, 39 met inclusion criteria (median follow-up: 73 months). Median OS was 31.5 vs. 65.0 months (p 0.238) and median PFS was 20.5 vs. 28.0 months (p = 0.081) for low- (n = 20) and high-DDI (n = 19), respectively. ORR was 78.9% vs. 100% (p = 0.105); CRR was 36.8% vs. 72.2% (p = 0.067). POD24 rates were similar (29.4% vs. 22.2%, p = 0.711). Patients were significantly older in the low-DDI group; other baseline features were comparable. Toxicity analysis showed no significant difference in grade ≥ 3 hematologic (p = 0.399) or non-hematologic (p = 0.920) events, or rate of hospitalization (p = 0.378) between elderly and very elderly. Secondary primary malignancies (SPM) occurred in 13 patients (34.2%), with no difference between groups. These findings support the feasibility of bendamustine dose reduction in elderly FL patients, showing no significant compromise in efficacy or increased toxicity. However, larger prospective studies are needed to confirm optimal dosing strategies in this population.

KI fragen

Bookmark

View Full Paper