North East and North Cumbria
ICS Formulary
 
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8 Malignant disease and immunosuppression
08-01-01 Alkylating drugs

Bendamustine
Formulary
  • Approved for the first line treatment of CLL (Binet stage B or C) in, patients for whom fludarabine combination chemotherapy is not appropriate in line with NICE. 
  • NECDAG approved for use in combination with rituximab for patients with CLL not fit for FCR chemotherapy and not fit for alemtuzumab. 
  • Approved for Low Grade Non-Hodgkins Lymphoma in line with NICE - not recommended for (low grade) non-Hodgkin's lymphoma that is refractory to rituximab or a rituximab-containing regimen NICE.
Link  MHRA Drug Safety Update (July 2017): Bendamustine (Levact): increased mortality observed in recent clinical studies in off-label use; monitor for opportunistic infections, hepatitis B reactivation
Link  MHRA Drug Safety Update (March 2021): Bendamustine (Levact): increased risk of non-melanoma skin cancer and progressive multifocal encephalopathy (PML)
Link  NICE TA216: Bendamustine for CLL

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Busulfan
Formulary
  • Approved formulations include:
    • 2mg tablets;
    • 25mg capsules (unlicensedunlicensed);
    • 60mg in 10ml injection.

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Carmustine
Formulary
  • Approved formualtions include 100mg injection and 7.7mg implants.
  • Approved for newly diagnosed glioblastoma multiforme (GBM) in line with NICE.
Link  NICE TA121: Glioma (newly diagnosed and high grade) - carmustine implants and temozolomide

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Chlorambucil
Formulary

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Chlormethine hydrochloride Ledaga®
Formulary
  • 160micrograms/g gel 
  • Approved for the treatment of mycosis fungoides-type cutaneous T-cell lymphoma in line with NICE
Link  NICE TA720: Chlormethine gel for treating mycosis fungoides-type cutaneous T-cell lymphoma

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Cyclophosphamide
Formulary

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Estramustine Phosphate
Formulary

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Ifosfamide
Formulary

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Lomustine
Formulary
  • Note: 10mg capsules are unlicensedunlicensed.

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Melphalan
Formulary
Link  NICE TA822: Melphalan for haematological diseases before allogeneic haematopoietic stem cell transplant (terminated appraisal)

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Thiotepa
Formulary

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Treosulfan  Trecondi®
Formulary
  • Approved in combination with fludarabine for malignant disease before allogeneic stem cell transplant in line with NICE and NHS England Commissioning Policy
Link  NICE TA640: Treosulfan with fludarabine for malignant disease before allogeneic stem cell transplant

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Melphalan flufenamide
Non Formulary
  • Melphalan flufenamide with dexamethasone for treating relapsed or refractory multiple myeloma (terminated appraisal)
Link  NICE TA968:Melphalan flufenamide with dexamethasone for treating relapsed or refractory multiple myeloma (terminated appraisal)

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Treosulfan  Trecondi®
Non Formulary
  • In combination with fludarabine before allogeneic stem cell transplant for people aged 1 month to 17 years with non-malignant diseases  (terminated appraisal).
Link  NICE TA945: Treosulfan with fludarabine before allogeneic stem cell transplant for people aged 1 month to 17 years with non-malignant diseases (terminated appraisal)

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