Effectiveness of Bendamustine-Rituximab Compared to R-CHOP/R-CVP as a First-Line Treatment of Indolent Non-Hodgkin’s Lymphoma or Mantle-Cell Lymphoma

Brenda Cristie Edina, Ikhwan Rinaldi


Background: R-CHOP/R-CVP is the only recommended first-line treatment for Non-Hodgkin’s Lymphoma (NHL). Limited treatment alternatives often lead to relapse and refractory NHL, which increases disease progressivity and worsens prognosis. Bendamustine-rituximab is being studied for its potential as a superior first-line therapy for indolent NHL and mantle-cell NHL (MCL); however, it is not in the national guidelines. Evidence-based research is needed to demonstrate the effectivity of bendamustine-rituximab compared to R-CHOP/R-CVP for a complete response of indolent NHL and MCL. Methods: A literature search was conducted using PubMed, Scopus, EBSCOHost, and Cochrane. Studies consistent with clinical question and eligibility criteria were included and critically appraised using the Oxford Centre for Evidence-Based Medicine (CEBM) tool. Results: Two randomized controlled trials (RCTs) were included in this study, both concluding that bendamustine-rituximab is superior to R-CHOP/R-CVP with a complete response, with RR values of 0.90 (95% CI 0.80 – 1.01) and 0.86 (95% CI 0.76 – 0.98). Conclusion: Bendamustine-rituximab is more effective than R-CHOP/R-CVP as a first-line treatment of indolent NHL or MCL.


internal medicine; medical journal; hematology oncology; medical oncology


GLOBOCAN 2018. Worldwide Cancer Incidence. Geneva: IARC WHO; 2019.

GLOBOCAN 2018. Indonesia Cancer Incidence. Geneva: IARC WHO; 2019.

Chiu BCH, Weisenburger DD. An update of the epidemiology of non-hodgkin’s lymphoma. Clin Lymphoma. 2003;4(3):161-8.

Komite Nasional Penanggulangan Kanker. Panduan Penatalaksanaan Limfoma Non-Hodgkin. Jakarta: Kementerian Kesehatan Republik Indonesia; 2015.

Coiffier B, Sarkozy C. Diffuse large B-cell lymphoma R-CHOP failure-what to do? Hematology Am Soc Hematol Educ Program. 2016;2016(1):366-78.

Dreyling M, Ghielmini M, Rule S, Salles G, Vitolo U, Ladetto M. Newly diagnosed and relapsed follicular lymphoma: ESMO clinical practice guidelines. Ann Oncol. 2016; 27(suppl5): v83-v90.

Dreyling M, Campo E, Hermine O, et al. Newly diagnosed and relapsed mantle cell lymphoma: ESMO clinical practice guidelines. Ann Oncol. 2017; 28(suppl 4): iv62-iv71.

Flinn IW, Jagt R, Kahl BS, et al. First-line treatment of patients with indolent non-hodgkin lymphoma or mantle-cell lymphoma with bendamustine plus rituximab versus R-CHOP or R-CVP: Results of the BRIGHT 5-year follow-up study. J Clin Oncol. 2019; 37(12):984-91.

Flinn IW, Jagt R, Kahl BS, et al. Randomized trial of Bendamustine-Rituximab or R-CHOP/R-CVP in first-line treatment of indolent NHL or MCL: The BRIGHT study. Blood. 2014;123(19):2944-52.

Rummel J, Nierdele N, Maschmeyer G, Banat GA, Grunhagen U, Losem C, et al.

Anna LK. Obat kanker limfoma diproduksi di dalam negeri, harga lebih terjangkau [Internet]. Jakarta: KOMPAS; 2018 [cited 2020 Mar 31]. Available from: https://sains.kompas.com/read/2018/01/29/090000923/obat-kanker-limfoma-diproduksi-di-dalam-negeri-harga-lebih-terjangkau.

Keputusan Menteri Kesehatan Republik Indonesia nomor HK. 01.07/MENKES/707/2018. Tentang Perubahan Atas Keputusan Menteri Kesehatan nomor HK.01.07/MENKES/659/2017. Tentang Formularium Nasional. Menteri Kesehatan Repulik Indonesia; 2018.

Ota I, Shinohara K, Muraki K, et al. Two cases of non-Hodgkin’s lymphoma in first degree relatives. Japanese Journal of Clinical Oncology. 2000;30(12):571-3.

GLOBOCAN 2018. Non-Hodgkin Lymphoma. Geneva: IARC WHO; 2019.

Mondello P, Steiner N, Willenbacher W, et al. Bendamustine plus Rituximab versus R-CHOP as first-line treatment for patients with follicular lymphoma grade 3A: Evidence from a multicenter, retrospective study. Oncologist. 23(4):454-60.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.