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Bendamustine + lenalidomide is a combination regimen used primarily in the treatment of relapsed or refractory multiple myeloma and has also been studied in other B-cell malignancies. Bendamustine is an alkylating agent (a nitrogen mustard derivative) that induces cell death by forming DNA crosslinks, leading to apoptosis and non-apoptotic cell death pathways. Lenalidomide is an immunomodulatory drug that alters cytokine production, enhances T-cell and natural killer (NK) cell activity, inhibits angiogenesis, and modulates the E3 ubiquitin ligase complex via cereblon binding—leading to degradation of key transcription factors essential for malignant B-cell survival. The combination leverages these complementary mechanisms to improve anti-tumor efficacy in hematologic cancers[1][5][6][8].
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