• Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia; anemia may occur; monitor for increased fatigue, dyspnea, and orthostatic hypotension.
• Monitor for symptoms of infusion reactions (fever, chills, pruritus, rash). May rarely cause severe allergic and anaphylactic reactions, especially in second and subsequent cycles. Discontinue therapy if severe reactions occur. Ask patient about symptoms suggestive of infusion reactions after first cycle of therapy. Consider using antihistamines, antipyretics, and corticosteroids in patients who previously experienced Grade 1 or 2 reactions. Consider discontinuation of therapy in patients with Grade 3 or 4 reactions.
• Assess for tumor lysis syndrome. Usually occurs during first cycle of bendamustine. May lead to acute renal failure and death. Maintain adequate volume status, close monitoring of blood chemistry, especially potassium and uric acid levels; use allopurinol during first 1–2 wk of therapy in high risk patients.
• Assess for skin reactions (rash, toxic skin reactions, bullous exanthema). Withhold or discontinue therapy if reactions are progressive or severe. If non-hematologic toxicity is ≥ Grade 3, reduce dose to 50 mg/m² on Days 1 and 2 of each cycle.
• Monitor intake and output, appetite, and nutritional intake. Assess for nausea and vomiting. Administration of an antiemetic before and during therapy and adjusting diet as tolerated may help maintain fluid and electrolyte balance and nutritional status.
• Monitor IV site for redness, swelling, pain, infection, and necrosis frequently during an after infusion. Extravasation may cause erythema, marked swelling, and pain.
• Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, and/or facial swelling, associated with involvement of other organ systems (hepatitis, nephritis, hematologic abnormalities, myocarditis, myositis) during therapy. May resemble an acute viral infection. Eosinophilia is often present. Discontinue therapy if signs occur.

Lab Test Considerations:

• Verify negative pregnancy test prior to starting therapy.Monitor CBC with differential and platelet count before and during therapy. The hematologic nadirs occur wk 3. Recovery usually occurs in 28 days. Hold dose and notify health care professional if ANC is ≥1 × 10⁹/L and platelet count is ≥75,000 × 10⁹/L.For patients treated for chronic lymphocytic leukemia: If hematologic toxicity ≥Grade 3, reduce dose to 50 mg/m² on Days 1 and 2. If Grade 3 or greater toxicity recurs, reduce dose to 25 mg/m² on Days 1 and 2. For patients treated for non-Hodgkin's lymphoma: If hematologic toxicity ≥Grade 4, reduce dose to 90 mg/m² on Days 1 and 2. If ≥ Grade 4 toxicity recurs, reduce dose to 60 mg/m² on Days 1 and 2.
  • Monitor blood chemistry, especially serum potassium and uric acid before and periodically during therapy. Allopurinol may be used during first wk of therapy to prevent tumor lysis syndrome.
  • Monitor liver function tests prior to starting and periodically during therapy, especially during first 3 mo of therapy.