IBR

Say it: I-B-R

Ibrutinib, bendamustine and rituximab

IBR adds the daily pill ibrutinib to the chemotherapy and antibody combination BR, mostly for chronic lymphocytic leukemia (CLL) that has come back.

Also called: Ibrutinib-BR, Ibrutinib plus BR, BR plus ibrutinib, Ibrutinib, bendamustine and rituximab

What it is

Bendamustine (chemotherapy) and rituximab (an antibody) quickly lower the number of leukemia cells. Ibrutinib is a targeted pill that blocks a signal (BTK) CLL cells need to survive, and it keeps working after the chemotherapy is done. The goal is to control CLL for a long time. Today, many people get targeted pills without chemotherapy instead, so IBR is used less often.

Often used for

• Chronic lymphocytic leukemia (CLL) that came back or did not respond to earlier treatment
• Sometimes mantle cell lymphoma

The medicines in this plan

Ibrutinib

A targeted pill (BTK inhibitor) taken by mouth once a day, every day. It is usually continued after the chemotherapy ends, as long as it keeps working.

Bendamustine

Chemotherapy given through a vein on days 1 and 2 of each 28 day cycle.

Rituximab

An antibody that targets CD20, a marker on CLL cells. Given through a vein on day 1 of each cycle.

How you get it

Bendamustine and rituximab are given in an outpatient infusion clinic on days 1 and 2 of each 28 day cycle, for up to 6 cycles. The first rituximab infusion is given slowly and can take most of a day; later ones are shorter. Ibrutinib is a pill you take at home every day, and it is usually continued after the 6 cycles. Your schedule may be different.

A typical cycle

Day 1

Blood tests, then pre-medicines, then rituximab and bendamustine through a vein.

Day 2

Bendamustine through a vein (a shorter visit).

Days 1 to 28

Ibrutinib pill once a day at home, at about the same time each day.

Days 3 to 28

Recovery. Blood counts are often lowest in the second and third weeks.

After 6 cycles

Chemotherapy and rituximab stop. Ibrutinib usually continues.

Common side effects and what helps

• Low blood counts and higher infection risk. Wash hands often and avoid sick people.
• Chills, fever or itching during the first rituximab infusion. Your nurse will slow it down and give medicines.
• Nausea. Take anti-nausea medicines as prescribed.
• Tiredness. Keep active with short walks and rest when you need to.
• Easy bruising or bleeding from ibrutinib. Use a soft toothbrush and an electric razor.
• Diarrhea. Drink fluids and ask your team which medicine to use.
• Muscle or joint aches. Gentle stretching may help.
• Rash. Tell your team, since bendamustine and other medicines can both cause it.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• A fast, pounding or uneven heartbeat, or feeling faint
• Bleeding that will not stop, black stools, vomiting blood, or a sudden bad headache
• Shortness of breath, cough or chest pain
• A blistering or peeling rash, or sores in the mouth
• Very high blood pressure readings, if you check at home
• A painful rash with blisters on one side of the body (shingles)

Good to know

• Ibrutinib can cause an uneven heart rhythm (atrial fibrillation) and high blood pressure. Your team will check your pulse and blood pressure often.
• Ibrutinib raises bleeding risk. Tell every doctor and dentist you take it, and ask your team before any surgery or procedure.
• You will be checked for hepatitis B before rituximab, because it can wake up an old infection.
• You may take medicines to prevent shingles and pneumonia, since bendamustine lowers immune cells for months.
• Many medicines and foods (such as grapefruit and Seville oranges) change ibrutinib levels. Check with your team before starting anything new.

At home

• Take ibrutinib with a glass of water at about the same time each day. Swallow it whole.
• Do not start aspirin, ibuprofen, fish oil or blood thinners without asking your team.
• Avoid grapefruit and Seville oranges.
• Check your temperature if you feel unwell, and keep the after hours number handy.
• Ask about vaccines before treatment; avoid live vaccines.

Questions to ask

• Why IBR for me, instead of a targeted pill without chemotherapy?
• How long will I keep taking ibrutinib?
• Should I check my blood pressure at home?
• Which medicines will I take to prevent infections?
• What should I do before dental work or surgery?

Leukemia

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.