Bendamustine in combination with rituximab can be made available within NHS Wales for the treatment of previously untreated and relapsed follicular lymphoma, marginal zone lymphoma and Waldenstrom’s macroglobulinaemia under the following circumstances:

• In the first-line setting, for use in fit patients with aggressive follicular lymphoma and marginal zone lymphoma where other licensed and health technology appraisal-approved regimens are unsuitable.
• In the relapsed setting, for use in patients with follicular lymphoma and marginal zone lymphoma where other licensed and health technology appraisal-approved regimens are unsuitable.
• For the treatment of Waldenstrom’s macroglobulinaemia for first-line and relapsed disease in patients deemed unsuitable for anthracycline-based regimens and/or where other licensed and health technology appraisal‑approved regimens are unsuitable.

The risks and benefits of the off-label use of bendamustine plus rituximab for this indication should be clearly stated and discussed with the patient to allow informed consent.

In March 2017 OWMAG recommended this treatment in NHS Wales, in February 2024 there was a review of the recommendation. OWMAG found nothing new that effects the original decision.

Next review: this advice will be reviewed after two years or earlier if new evidence becomes available.