Atrial fibrillation following bendamustine in three lymphoma patients

IntroductionBendamustine is a chemotherapeutic agent combining alkylating activity with purine analogue properties used for a wide range of malignancies including lymphoma. It is not generally associated with cardiac toxicity.Case reportIn this report, we describe 3 cases of patients with marginal zone lymphoma (MZL), diffuse large B-cell lymphomas (DLBCL), and relapsed classic Hodgkin lymphoma (cHL), who developed atrial fibrillation (AF) 1 to 2 days post bendamustine initiation at a dose ranging from 70-90 mg/m².Management and outcomesThe patients were managed with bisoprolol ± digoxin and anticoagulation. They continue to be in AF and are under routine follow-up by cardiology. The patients' lymphoma treatment regimens were changed to alternatives except for the last case, in which she was challenged with another subsequent exposure to bendamustine before she passed away.DiscussionOld age, hypertension (HTN), diabetes, and ischemic heart disease (IHD) were possible risk factors for AF. However, one of the reported cases is a patient without any known risk factors. Further studies are needed to confirm this observation, to identify patients at risk, and to investigate the underlying mechanisms of bendamustine-induced AF.