Treanda: 7 things you should know

Medically reviewed by Carmen Pope, BPharm. Last updated on Aug 28, 2023.

1. How it works

• Treanda is a brand (trade) name for bendamustine hydrochloride (HCL) which may be used to treat chronic lymphocytic leukemia (CLL) and a certain type of non-Hodgkin lymphoma.
• Although the exact way Treanda works is not known, its structure means that it readily forms bonds with other electron-rich molecules, which result in interstrand DNA crosslinks and very strong (covalent) bonds. Because cancer cells divide more rapidly than normal cells, they are more affected by this bonding and the death rate of cancerous cells is greater than the death rate of normal cells. This slows the growth of cancer cells in the body.
• Treanda belongs to the class of medicines known as alkylating agents. It may also be called a nitrogen mustard derivative or a cytotoxic agent. A cell cycle goes through three phases: resting, active growing, and mitosis (division). Alkylating agents work best in the resting phase of the cell cycle, although they may also work in the active phase.
• Bendeka replaced Treanda in 2016 although Treanda is still available through Cephalon, a subsidiary company of Teva. This was because Bendeka is compatible with polycarbonate or acrylonitrile-butadiene-styrene (ABS)-containing infusion equipment, and Treanda is not. Bendeka also has a shorter infusion time than Treanda. Bendeka has the same indications for use and side effects as Treanda.

2. Upsides

• May be used to treat chronic lymphocytic leukemia (CLL).
• May also be given to people with slow-growing (indolent) B-cell non-Hodgkin lymphoma (NHL) that has progressed despite treatment with rituximab or a rituximab-containing regimen within the past 6 months.
• For CLL, Treanda 100mg/m² is administered as a 30-minute infusion into a vein on days 1 and 2 of a 28-day treatment cycle. The treatment cycle may be repeated up to six times.
• For NHL, Treanda 120mg/m² is administered as a 60-minute infusion into a vein on days 1 and 2 of a 21-day treatment cycle. The treatment cycle may be repeated up to eight times.
• Lung nodules are not commonly found after Treanda and Rituxan therapy. Lung nodules are commonly found during routine X-rays, showing up on one in every 500 X-rays. Most are benign (noncancerous). Interstitial lung disease is considered a rare complication of Treanda plus rituximab therapy but one that doctors should monitor for because it may be potentially fatal.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Black tarry stools, bleeding gums, blood in the urine or stools, diarrhea, constipation, cough, difficulty breathing, headache, loss of appetite, low red and white blood cells, low platelets, mouth ulcers and irritation, nausea, rash, tiredness, swelling of the eyelids, face, lips, hands, or feet, and weight loss are the most commonly reported side effects.
• Other side effects that may occur include infections or a recurrence of infections, kidney or liver damage, other cancers, and leaking of Treanda into the surrounding skin causing tissue damage. Infusion reactions, causing symptoms such as fever, chills, pruritus, and a rash, are common. Severe allergic reactions are rare. Consider treatment with antihistamines, antipyretics, and corticosteroids in subsequent cycles in patients who have experienced Grade 1 or 2 infusion reactions.
• Severe myelosuppression (Grade 3-4) occurred in 98% of patients in two studies. 2% of patients died as a result. Monitor complete blood counts, including leukocytes, platelets, hemoglobin, and neutrophils frequently.
• People treated with Treanda are more susceptible to infections, such as pneumonia, sepsis, septic shock, and hepatitis; some may cause death. Advise patients to contact their physician at the first sign of an infection.
• Treanda may need to be temporarily or permanently stopped if Grade 4 hematologic toxicity or greater than or equal to Grade 2 non-hematologic toxicity occurs. Once blood counts have improved and the toxicity improved to less than or equal to Grade 1 then Treanda may be reinitiated if desired. Consider a dosage reduction.
• Must be administered by a health professional, either in their offices, a hospital, or at an infusion center. Treanda is a cytotoxic drug and special handling and disposal procedures must be followed.
• Avoid in people with moderate to severe kidney disease (CL_CR30 mL/min) or with AST or ALT values of 2.5 to 10 times the upper limit of normal or total bilirubin levels of 1.5 to 3 times the upper limit of normal.
• Although Treanda is more effective at killing cancerous cells compared to normal cells, normal cells are still affected, which results in side effects. Normal cells most affected by chemotherapy with Treanda are blood cells, and cells in the mouth, stomach, and bowel.
• Tumor lysis syndrome has been reported with Treanda, typically within the first cycle of treatment. Consider preventive measures, such as vigorous hydration and close monitoring of laboratory values, particularly potassium and uric acid levels. Allopurinol has also been used at the start of Treanda treatment (although this may increase the risk of severe skin toxicity).
• Fatal and serious skin reactions have also been reported with Treanda, such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Other serious effects include serious and fatal cases of liver injury (usually within the first 3 months), and malignancies, such as myelodysplastic syndrome, or acute myeloid leukemia.
• Treanda must be kept in a refrigerator before use (at 2°C to 8°C [36°F-46°F]).
• Cannot be used with closed system transfer devices (CSTDs), adapters, and syringes containing polycarbonate or acrylonitrile-butadiene-styrene (ABS) as significant absorption of the active ingredient bendamustine to surfaces containing these ingredients will occur.
• Only polypropylene syringes with a metal needle and polypropylene hub can be used to withdraw and transfer Treanda Injection into the infusion bag. Polypropylene syringes are translucent in appearance.
• Two types of Treanda formulations are available, which may cause some confusion: Treanda Injection and Treanda for Injection which is a powder that requires mixing with sterile water before diluting. The concentration of bendamustine hydrochloride differs in these preparations
• Treanda can cause fetal harm when administered to a pregnant woman. Females of reproductive potential should use effective contraception during treatment with Treanda and for at least 6 months after the final dose. Males with female partners of reproductive potential should use effective contraception during treatment and for at least 3 months after the final dose. Breastfeeding is not recommended during Treanda treatment and for at least one week after the final dose. Treanda may impair male fertility.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Treanda is a cytotoxic agent that must be administered by a health professional and may be used to treat chronic lymphocytic leukemia (CLL) and a certain type of non-Hodgkin lymphoma. It can cause serious side effects such as severe myelosuppression, liver toxicity, and infusion site reactions. Effective contraception should be used during treatment because Treanda can cause harm to a developing baby and it may impair fertility in males. Response rates of 59% for CLL and 74% for NHL have been reported.

5. Tips

• Treanda is a cytotoxic drug and must be administered by a health professional in a doctor's office with monitoring equipment. Tell your doctor if any adverse events happen during the infusion or soon afterward, such as rash, diarrhea, nausea or vomiting, or tiredness. If you notice any leakage of Treanda during your infusion, tell the nurse/doctor straight away and wash the skin immediately with soap and water.
• If you experience any allergic-type reactions, such as rash, facial swelling, or difficulty breathing, tell your doctor immediately.
• While you are being administered Treanda you will need frequent monitoring of your white blood cells, platelets, and red blood cells. Report any signs of infection to your doctor.
• Treanda can cause serious side effects, such as liver toxicity. Tell your doctor if you experience any signs of liver failure, such as yellowing of the skin or eyes, anorexia, bleeding, or easy bruising.
• Treanda may cause tiredness and affect your ability to drive or operate machinery. Do not drive or perform complex tasks if it affects you like this.
• Tell your doctor or other health care provider about all the medicines you take, including prescription and over-the-counter (OTC) medicines, vitamins, and herbal supplements.
• Always tell your doctor about other underlying conditions you may have, such as heart rhythm disturbances.
• Treanda is harmful to a developing baby and you should not take it if you are pregnant and for 6 months after the final dose. If you inadvertently become pregnant while taking Treanda, tell your doctor right away. Females should also not breastfeed while being administered Treanda and for at least 1 week following the final dose. Treanda may also impair the fertility of males who have been administered it.

6. Response and effectiveness

• The effectiveness of Treanda has been investigated in several trials. 59% of patients with Binet Stage B CLL responded to Treanda compared with 26% of those assigned chlorambucil. A complete response was reported in 8% of people, compared to < 1% with the chlorambucil. Progression-free survival was reported as 18 months with Treanda and 6 months with chlorambucil.
• For non-Hodgkin lymphoma, the overall response rate was 74% with Treanda, and 13% of patients reported a complete response. The duration of the response was a median of 9.2 months.

7. Interactions

Medicines that interact with Treanda may either decrease its effect, affect how long it works, increase side effects, or have less of an effect when taken with Treanda. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with Treanda include:

• allopurinol
• anticonvulsants such as carbamazepine or phenobarbital
• antipsychotics, such as clozapine
• azathioprine
• biologics, such as adalimumab
• brewer's yeast or probiotics, such as Bifidobacterium infantis or Lactobacillus sp.
• caffeine
• chloramphenicol
• ciprofloxacin or norfloxacin
• daunorubicin or doxorubicin
• deferiprone
• echinacea
• esomeprazole
• etanercept
• fingolimod
• ganciclovir
• heart medications such as amiodarone
• hydroxyurea
• isoniazid
• live vaccines, such as the BCG vaccine, hepatitis vaccines, live influenza vaccine, mumps, or the measles vaccine
• mercaptopurine
• methotrexate
• ozanimod
• pegfilgrastim
• rifampin
• vitamin e
• zidovudine.

Coadministration with CYP1A2 inhibitors, such as ciprofloxacin, enoxacin, or fluvoxamine may increase the risk of side effects of Treanda. Coadministration with CYP1A2 inducers, such as phenytoin, rifampin, ritonavir, or smoking may decrease the effectiveness of Treanda.

Note that this list is not all-inclusive and includes only common medications that may interact with Treanda. You should refer to the prescribing information for Treanda for a complete list of interactions.

References

• Treanda (bendamustine). Updated 10/2022. Cephalon, Inc. https://www.drugs.com/pro/treanda.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Treanda only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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