Bendamustine (Levact)

Bendamustine is a chemotherapy drug. You pronounce bendamustine as ben-dah-mus-teen.

It is also known as Levact.

Bendamustine is a treatment for:

• non-Hodgkin lymphoma 
• chronic lymphocytic leukaemia 
• myeloma 

How does bendamustine work?

Bendamustine is a type of chemotherapy drug called an alkylating drug . 

These drugs work by interfering with the DNA in cancer cells. The cells can’t divide into 2 new cells so the cancer can’t grow.

How do you have bendamustine?

You have bendamustine as a drip into your bloodstream (intravenously). Each treatment takes between 30 and 60 minutes.

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

How often do you have bendamustine?

You have bendamustine in cycles of treatment . How often you have it and for how long depends on what cancer you have.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Hepatitis B reactivation

Tell your doctor if you have had hepatitis B (a liver infection) in the past. Bendamustine can make it active again. Your doctor or nurse will talk to you about this and may test you for it.

What are the side effects of bendamustine?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums or nosebleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tiredness and weakness (fatigue) 

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Inflammation of the digestive system

This treatment may cause inflammation of the digestive system . This can cause pain and soreness.

It might include one or all of the following:

• the throat

• food pipe (oesophagitis)

• the tummy (stomach)

• the back passage (rectum)

You can have painkillers to reduce the soreness. Take them half an hour before meals to make eating easier. Your nurse, doctor or dietician will explain the best foods to have if you have any of these symptoms.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• hair loss or thinning

• a drop in red blood cells causing tiredness and breathlessness

• difficulty sleeping (insomnia)

• heart changes (such as a fast heartbeat)

• high or low blood pressure

• diarrhoea or constipation

• changes to how well the liver works

• allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness. Some allergic reactions can be life threatening, alert your nurse or doctor if notice any of these symptoms.

• loss of appetite

• changes to how well the kidneys work

• difficulty breathing

• feeling dizzy

• shivering or shaking (chills)

• lack of fluid in the body (dehydration)

• high levels of chemicals in your blood due to the breakdown of tumour cells. This called tumour lysis syndrome. You have regular blood tests to check for this.

• sore mouth and ulcers

• changes to the lung tissue that can cause cough and breathlessness. Rarely this can be life threatening.

• pain in different parts of the body

• low potassium levels in the blood

• skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes. It is important to check your skin regularly for any abnormal areas.

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• a serious reaction to an infection (sepsis). Signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms.

• fluid around the heart

• heart attack

• a second blood cancer such as acute myeloid leukaemia (AML) or myelodysplastic syndrome MDS). Talk to your doctor if this is a concern for you.

• sleepiness

• an increased risk of non melonoma skin cancer. Your doctor will check your skin for any signs of this.

Other side effects

There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:

• a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening.

• a very rare infection called progressive multifocal leukoencephalopathy (PML). It affects the brain and spinal cord. Symptoms include changes in behaviour and personality, clumsiness, feeling weak, difficulty moving, eyesight changes and memory problems.

• liver stops working

• kidneys stop working

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Having blood after this treatment

After having this treatment you should only have blood or platelets that are first treated with radiation (irradiated). The radiation lowers the risk of a reaction between your blood cells and the cells in the transfusion. No harm comes from the irradiated blood.

In your medical records there is a note saying you should only have irradiated blood. You have a card to carry with this information. This is in case you need treatment at another hospital.

Pregnancy and contraception 

This drug may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment with this drug and for at least 6 months after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.

Fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.