Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2003 May;129(5):316-9.
doi: 10.1007/s00432-003-0441-y. Epub 2003 May 17.

Pneumocystis carinii pneumonia as a complication of bendamustine monotherapy in a patient with advanced progressive breast cancer

A Klippstein  1 , C P Schneider, H G Sayer, K Höffken
Affiliations
Case Reports

Pneumocystis carinii pneumonia as a complication of bendamustine monotherapy in a patient with advanced progressive breast cancer

A Klippstein et al. J Cancer Res Clin Oncol. 2003 May.

Abstract

Background: Bendamustine is an alkylator with anticipated antimetabolic activity. It has shown activity in malignant lymphoma, multiple myeloma, and breast cancer. Recognized side-effects are relatively mild with myelosuppression as the dose-limiting toxicity. The CD4/CD8 ratio may be reduced. To what extent the alteration of lymphocytes, especially CD4(+) lymphocytes, correlates with an increase in opportunistic infections cannot be definitively answered.

Case report: The patient, female, aged 48 years, was suffering from an advanced progressive breast cancer. After initial treatment with several chemotherapies, a cytotoxic therapy was initiated, with bendamustine (150 mg/m(2)) administered on two consecutive days and repeated every 4 weeks. After five courses, the patient developed Pneumocystis carinii pneumonia (PCP), disclosed in the bronchoalveolar lavage. While receiving bendamustine therapy, the CD4(+) and CD8(+) lymphocyte counts in the peripheral blood were determined by flow cytometry. The next-to-normal CD4/CD8 ratio before therapy (0,82) had decreased to 0,05 during the therapy mainly due to a decline of CD4(+) lymphocyte. The patient was seronegative for human immunodeficiency virus. In spite of high-dose intravenous trimethoprim/sulfamethoxazole and methylprednisolone application, the patient died of a respiratory failure 3 days after PCP was diagnosed.

Conclusion: Bendamustine is capable of inducing a reduction in CD4(+) lymphocyte counts causing a severe T-lymphocyte-mediated immunosuppression. Measuring CD4(+) lymphocyte counts may be helpful in determining the risk of PCP in patients treated with bendamustine.

PubMed Disclaimer

Figures

Fig. 1a,b. a
Fig. 1a,b. a
CD4/CD8 ratio of a female patient with advanced breast cancer before, after two, and after four courses of bendamustine. The ratio is substantially declined after bendamustine application; b CD4+ lymphocyte count of a female patient with advanced breast cancer before, after two, and after four courses of bendamustine. The cell count is markedly declined after bendamustine application
Fig 2.
Fig 2.
Chest X-ray of a female patient with advanced breast cancer developing PCP after bendamustine application
See this image and copyright information in PMC

References

    1. Strumberg D, Harstrick A, Doll K, et al (1996) Bendamustine hydrochloride activity against doxorubicine-resistant human breast carcinoma cell lines. Anti Cancer Drugs 7:415–421 - PubMed
    1. Reck M, Haering B, Koschel G, et al (1998) Chemotherapie des fortgeschrittenen nicht-kleinzelligen und kleinzelligen Bronchialkarzinoms mit Bendamustin—Eine Phase-II-Studie. Pneumologie 52:571–574 - PubMed
    1. Rahn AN, Schilcher RB, Adamietz IA, et al (2001) Palliative Radiochemotherapie mit Bendamustin bei fortgeschrittenen Tumorrezidiven im HNO-Bereich. Strahlenther Onkol 177:189–194 - PubMed
    1. Bremer K, Roth W (1996) Bendamustine, a low-toxic nitrogen-mustard derivative with high efficacy in malignant lymphomas. Tumordiagn Ther 17:1–6
    1. Matthias M, Preiss R, Sohr R, Possinger K (1995) Pharmakokinetics of bendamustine in patients with malignant tumors. Proc Am Assoc Clin Oncol 14:458 [abstr]

Publication types

MeSH terms

Substances