Older individuals with chronic lymphocytic leukemia (CLL) who were treated with bendamustine and rituximab (BR) experienced similar efficacy and toxicity when compared with younger patients, according to the results of an observational retrospective analysis.

Recently reported in the British Journal of Haematology, the results suggest that risk-adapted dosing of BR may be beneficial and tolerable for elderly patients with CLL.

The study included 114 patients who were diagnosed with CLL between 2007 and 2016 and received BR. All patients were identified from the Stockholm region in Sweden using a regional registry. Patients were stratified by age: younger than 73 years (79 patients), aged between 73 and 79 years (39 patients), and 80 years or older (23 patients).

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Patients 80 years or older tended to be treated with a reduced dose of bendamustine, with only 15% receiving a full dose — and received fewer median cycles of bendamustine than younger patients. This age group also tended to delay initiation of rituximab, with 65% of patients not starting the agent until the second treatment cycle.

The overall response rate was similar across age subgroups, and a multivariate analysis revealed that age was not significantly associated with progression-free survival (P =.087); only Eastern Cooperative Oncology Group performance status (P =.009) and cytogenetic status (P =.000) were.

Patients 80 years or older also had similar rates of grade 3 or higher infections as younger patients (17% vs 20%, respectively) and grade 3/4 thrombocytopenia (26% vs 32%, respectively). No patients in the study had grade 3 or higher anemia, and less frequent grade 3/4 neutropenia was seen among patients 80 years or older compared with younger patients (44% vs 73%, respectively).

The study authors concluded that the findings “show that carefully risk-adapted BR is a safe and effective regimen even in patients above 80 years of age, and may represent an alternative treatment to chlorambucil combined with a CD20 antibody.”

Disclosure: Some of the authors disclosed financial relationships with the pharmaceutical industry. For a full list of disclosures, please refer to the original study.


Mattsson A, Sylvan SE, Asklid A, et al. Risk-adapted bendamustine + rituximab is a tolerable treatment alternative for elderly patients with chronic lymphocytic leukaemia: a regional real-world report on 141 consecutive Swedish patients. Br J Haematol. Published online August 10, 2020. doi:10.1111/bjh.17032