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

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Busulfan
Formulary
  • Approved formulations include:
    • 2mg tablets;
    • 25mg capsules (unlicensedunlicensed);
    • 60mg in 10ml injection.

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
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

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Chlorambucil
Formulary

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
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

Red View adult BNF  View SPC online  View childrens BNF
Cyclophosphamide
Formulary

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Ifosfamide
Formulary

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Lomustine
Formulary
  • Note: 10mg capsules are unlicensedunlicensed.

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Melphalan
Formulary
Link  NICE TA822: Melphalan for haematological diseases before allogeneic haematopoietic stem cell transplant (terminated appraisal)

Cytotoxic Drug  Red View adult BNF  View SPC online  View childrens BNF
Thiotepa
Formulary

Red View adult BNF  View SPC online  View childrens BNF
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

Red View adult BNF  View SPC online  View childrens BNF
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)

Cytotoxic Drug  Not Recomended View adult BNF  View SPC online  View childrens BNF
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)

Not Recomended View adult BNF  View SPC online  View childrens BNF