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.