From the Guidelines
The recommended prophylaxis for bendamustine and rituximab (Rituxan) therapy includes Pneumocystis jirovecii pneumonia (PJP) prophylaxis, which should be considered for patients receiving this combination, as stated in the NCCN guidelines 1.
Prophylaxis Components
The following components are recommended:
- Antimicrobial prophylaxis with trimethoprim-sulfamethoxazole or pentamidine inhalation for PJP prevention
- Antiviral prophylaxis to prevent herpes virus reactivation
- Hepatitis B screening with antiviral prophylaxis for HBsAg-positive patients
- Growth factor support with G-CSF for patients at high risk of neutropenia
- Antiemetic prophylaxis with 5-HT3 antagonists before bendamustine administration
Rationale
Bendamustine and rituximab combination therapy causes significant immunosuppression, increasing the risk of opportunistic infections, particularly in patients with underlying hematologic malignancies who may already have compromised immune function 1.
Key Considerations
- The NCCN guidelines recommend considering PJP prophylaxis for patients receiving bendamustine and rituximab 1
- The choice of prophylaxis components may vary depending on individual patient factors and risk assessment
- Regular monitoring and adjustment of prophylaxis measures may be necessary to minimize the risk of adverse events and optimize patient outcomes 1
From the Research
Recommended Prophylaxis for Bendamustine and Rituxan
- The recommended prophylaxis for bendamustine and Rituxan is not explicitly stated in the provided studies, but some studies suggest the use of premedications to prevent infusion-related reactions (IRRs) and febrile neutropenia (FN) 2, 3.
- One study suggests the use of ondansetron 16 mg orally and dexamethasone 10 mg IV push prior to each infusion of bendamustine to prevent IRRs 2.
- Another study compares the outcomes of primary and secondary prophylaxis of chemotherapy-induced and febrile neutropenia in bendamustine plus rituximab regimens, and finds that primary prophylaxis with granulocyte colony stimulating factors (G-CSFs) may reduce the risk of chemotherapy dose delays 3.
- The use of G-CSFs, such as filgrastim or pegfilgrastim, is also mentioned in other studies as a way to prevent febrile neutropenia in patients receiving bendamustine and rituximab 3, 4.
Prevention of Infusion-Related Reactions
- Infusion-related reactions (IRRs) are a common adverse effect of bendamustine and rituximab, and can be prevented with the use of premedications such as ondansetron and dexamethasone 2.
- One study finds that the incidence of IRRs is lower in patients receiving bendamustine alone compared to those receiving rituximab infusions 2.
- Another study finds that the incidence of rituximab-associated infusion reactions is lower in elderly patients compared to younger patients 5.
Prevention of Febrile Neutropenia
- Febrile neutropenia (FN) is a common adverse effect of chemotherapy, and can be prevented with the use of G-CSFs such as filgrastim or pegfilgrastim 3, 4.
- One study finds that the incidence of FN is lower in patients receiving primary prophylaxis with G-CSFs compared to those receiving secondary prophylaxis 3.
- Another study finds that the incidence of FN is lower in elderly patients compared to younger patients 5.