Appropriate use of bendamustine in first-line therapy of chronic lymphocytic leukemia. Recommendations from SIE, SIES, GITMO Group

• By using the GRADE system we produced recommendations on 3 key issues on the use of bendamustine in the front line setting in CLL.
• Bendamustine with rituximab was recommended in elderly fit patients potentially eligible to FCR.
• Bendamustine alone was recommended in patients who are candidate to chlorambucil alone.
• Rituximab–bendamustine was recommended in patients not eligible to FCR, but suitable to receive rituximab.
• Consensus-based recommendations addressed evidence-orphan issues on the use of this drug in the front-line setting in CLL.

By using the GRADE system we produced the following recommendations for the use of bendamustine in the first-line treatment of CLL: (1) bendamustine with rituximab is recommended in elderly fit patients potentially eligible to FCR; (2) Bendamustine alone is recommended in patients who are candidate to chlorambucil alone; (3) Rituximab–bendamustine is recommended in patients not eligible to FCR, but suitable to receive rituximab. Consensus-based recommendations addressed evidence-orphan issues concerning the use of bendamustine in genetically-defined high-risk patients and the appropriate dose of bendamustine as single agent or in association with rituximab.