Leukemia/BMT Chemotherapy Regimens

The information contained in these regimens is a statement of consensus of NCCP and ISMO or IHS professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. The treatment regimen to be used should take into account factors such as histology, molecular pathology, age, performance status, co-morbidities and the patient’s preference.Each treatment regimen has advantages and disadvantages, and there may be more than one good option.  In addition, treatment choices can change over time as more evidence becomes available. Use of these documents is the responsibly of the prescribing clinician and is subject to the HSE.ie terms of use.

Please email any comments or feedback on these regimens to oncologydrugs@cancercontrol.ie.

Leukemia/BMT Chemotherapy Regimens

Regimen Name Indication

Azacitidine 75mg/m2  5-2-2 Therapy

Regimen

00287a

Intermediate-1 and low risk myelodysplastic syndromes (MDS) according to the International Prognostic Scoring System (IPSS).

00287b

Treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with Intermediate-2 and high risk myelodysplastic syndromes (MDS) according to the International Prognostic Scoring System (IPSS).

00287c

Treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with Chronic myelomonocytic leukaemia (CMML) with 10-29% marrow blasts without myeloproliferative disorder.

00287d

Treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with Acute myeloid leukaemia (AML) with20-30% blasts and multi-lineage dysplasia, according to WHO classification.

Azacitidine 100mg/m2 5-day Therapy

Regimen

00288a

Intermediate-1 and low risk myelodysplastic syndromes (MDS) according to the International Prognostic Scoring System (IPSS).

00288b

Treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with Intermediate-2 and high risk myelodysplastic syndromes (MDS) according to the International Prognostic Scoring System (IPSS).

00288c

Treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with Chronic myelomonocytic leukaemia (CMML) with 10-29% marrow blasts without myeloproliferative disorder.

00288d

Treatment of adult patients who are not eligible for haematopoietic stem cell transplantation with Acute myeloid leukaemia (AML) with 20-30% blasts and multi-lineage dysplasia, according to WHO classification.

BEAM Autologous Transplant Conditioning Protocol

Regimen

00408a 

Autologous conditioning in non-Hodgkins Lymphoma (NHL)

00408b

Autologous conditioning in Hodgkins Lymphoma

Chlorambucil 10mg/m2 Therapy

Regimen

00411b

Treatment of patients with Chronic Lymphocytic Leukaemia

Cladribine 0.14mg/day Day 1 to 5 Therapy

Regimen

00402a

First line treatment for adult patients with Hairy Cell Leukaemia

Cladribine 0.14mg/kg Weekly Therapy

Regimen

00469a

First line treatment for adult patients with Hairy Cell Leukaemia

Bosutinib Monotherapy

Regimen

00224a

Treatment of adult patients with chronic phase, accelerated phase, and blast phase Ph+CML previously treated with one or more TKI(s) and for whom imatinib, nilotinib and dasatinib are not considered appropriate treatment options.

High Dose Cytarabine Therapy

Regimen

00365a

Consolidation chemotherapy for the treatment of patients with Acute Myeloid Leukaemia (AML)

Intermediate Dose Cytarabine Therapy

Regimen

00364a

Consolidation chemotherapy for the treatment of patients Acute Myeloid Leukaemia (AML)

DA(60/100) 3+10: Course 1 Induction Therapy (AML-17)

Regimen

00359a

Induction chemotherapy regimen for the treatment of patients with de novo or secondary Acute Myeloid Leukaemia (AML)

DA (50/100) (3+8) Course 2 Induction Therapy (AML-17)

Regimen 

00360a

Induction chemotherapy regimen for the treatment of patients with de novo or secondary Acute Myeloid Leukaemia (AML)

Decitabine Monotherapy – AML (28 day cycle)

Regimen

00231a

Treatment of adult patients aged 65 years and above with newly diagnosed de novo or secondary AML, according to the WHO classification, who are not candidates for standard induction chemotherapy.

Fludarabine, Cyclophosamide and riTUXimab ( FC (IV) and R) Therapy

Regimen

00241a

Treatment of B-cell chronic lymphocytic leukaemia (CLL).

Fludarabine, Cyclophosamide and riTUXimab ( FC (Oral) and R) Therapy

Regimen

00410a

Treatment of B-cell chronic lymphocytic leukaemia (CLL).

LEAM Autologous Transplant Conditioning Protocol

Regimen

00468a

Autologous conditioning in non-Hodgkins Lymphoma (NHL)

00468b

Autologous conditioning in Hodgkins Lymphoma

R-Gemcitabine (1000mg/m2) Oxaliplatin Therapy[i] - 14 day

Regimen

00506a

Relapsed or refractory CD20 positive diffuse large B cell lymphoma in patients ineligible for stem cell transplant.

Ibrutinib Therapy CLL -  Waldenström’s macroglobulinaemia

Regimen

00296a

As a single agent for the treatment of adult patients with chronic lymphocytic leukaemia (CLL) who have received at least one prior therapy.

00296b

As a single agent for the treatment of adult patients with chronic lymphocytic leukaemia (CLL) in first line in the presence of 17p deletion or TP53 mutation in patients unsuitable for chemo-immunotherapy.

00296c

As a single agent for the treatment of adult patients with Waldenström’s macroglobulinaemia (WM) who have received at least one prior therapy, or in first line treatment for patients unsuitable for chemo-immunotherapy.

Idelalisib Monotherapy

Regimen

00291a

Monotherapy for the treatment of adult patients with follicular lymphoma (FL) that is refractory to two prior lines of treatment.

Idelalisib and riTUXimab Therapy

Regimen

In combination with riTUXimab for the treatment of adult patients with chronic lymphocytic leukaemia (CLL):

00389a

who have received at least one prior therapy

or

00389b

as first line treatment in the presence of 17p deletion or TP53 mutation in patients who are not eligible for any other therapies.

Idelalisib and Ofatumumab Therapy

Regimen

In combination with Ofatumumab for the treatment of adult patients with chronic lymphocytic leukaemia (CLL):

00390a

who have received at least one prior therapy

or

00390b

as first line treatment in the presence of 17p deletion or TP53 mutation in patients who are not eligible for any other therapies.

Tretinoin (ATRA) with Arsenic Trioxide (ATO) Induction Therapy

Regimen

00356a

Treatment of patients with newly diagnosed low to intermediate risk Acute Promyelocytic Leukaemia (APL)

Tretinoin (ATRA) with Arsenic Trioxide (ATO) Consolidation Therapy

Regimen

00357a

Treatment of patients with low to intermediate risk Acute Promyelocytic Leukaemia (APL) with haematological complete remission (CR) after induction treatment with tretinoin (ATRA) and arsenic trioxide (Ref NCCP Protocol 00356).

FLAG: Ida 8mg/m2 Therapy

Regimen

00362a

Induction of chemotherapy regimen for the treatment of patients with de novo, secondary Acute Myeloid Leukaemia (AML), or biphenotypic leukaemia.

00362b

Treatment of patients with blast count (>10%) Myelodysplastic Syndrome

00362c

Salvage regimen for patients with relapsed/refractory acute leukaemia

Venetoclax Monotherapy

Regimen

00400a

Treatment of chronic lymphocytic leukaemia (CLL) in the presence of 17p deletion or TP53 mutation in adult patients who are unsuitable for or have failed a B-cell receptor pathway inhibitor Treatment of CLL in the absence of 17p deletion or TP53 mutation in adult patients who have failed both chemoimmunotherapy and a B-cell receptor pathway inhibitor

Obinutuzumab and Chlorambucil Therapy

Regimen

00286a

Treatment of adult patients with previously untreated chronic lymphocytic leukaemia (CLL) and with comorbidities making them unsuitable for full-dose fludarabine based therapy.

PONATinib Therapy

Regimen

00302a

Treatment of adult patients with chronic phase, accelerated phase, or blast phase chronic myeloid leukaemia (CML) who are resistant to dasatinib or nilotinib; who are intolerant to dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation.

00302b

Treatment of adult patients with Philadelphia chromosome positive acute lymphoblastic leukaemia (Ph+ ALL) who are resistant to dasatinib; who are intolerant to dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation.

Ruxolitinib Monotherapy

Regimen

The treatment of disease-related splenomegaly or symptoms in adult patients with:

00229a

Primary myelofibrosis (chronic idiopathic myelofibrosis)

00229b

Post polycythaemia vera myelofibrosis

00229c

Post essential thrombocythaemia myelofibrosis

Tretinoin (ATRA) /Idarubicin (PETHEMA  AIDA) Induction Therapy : High Risk

Regimen

00366a

Treatment of patients with newly diagnosed high risk Acute Promyelocytic Leukaemia (APL)