Lymphoma & Myeloma 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 responsibility of the prescribing clinician and is subject to the HSE.ie terms of use.

NCCP Guidance on riTUXimab rapid infusion rate is available here

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

Lymphoma and Myeloma Chemotherapy Regimens

Regimen Name Indication

ABVD Therapy

Regimen

00290a

Hodgkin’s Lymphoma.

BEAM Autologous Transplant Conditioning Protocol

Regimen

00408a

Autologous conditioning in non-Hodgkins Lymphoma (NHL)

00408b

Autologous conditioning in Hodgkins Lymphoma

Bendamustine Monotherapy

Regimen

00527a

Treatment of patients with relapsed or refractory Chronic Lymphocytic Leukaemia (CLL

Bortezomib Maintenance Therapy- 14 day

Regimen

00435a

Maintenance treatment for patients with high risk  multiple myeloma

Bortezomib and Dexamethasone Therapy

Regimen

00270a

Treatment of adult patients with progressive multiple myeloma who have received at least one prior therapy.

Bortezomib, Lenalidomide and Dexamethasone (RVD) Therapy-21 day*

Regimen

00416a

Treatment of newly diagnosed myeloma in adult patients with high risk features.

00416b

Treatment of relapsed or refractory myeloma that has received prior therapy in adult patients with high risk features.

Bortezomib, Thalidomide and Dexamethasone (VTD) Induction Therapy

Regimen

00274a

Bortezomib, thalidomide and dexamethasone for induction treatment of adult patients with previously untreated multiple myeloma who are eligible for high-dose chemotherapy with haematopoietic stem cell transplantation.

Bortezomib, Melphalan and Prednisolone Therapy

Regimen

00275a

Treatment of adult patients with previously untreated multiple myeloma who are not eligible for high-dose chemotherapy with haematopoietic stem cell transplantation.

Carfilzomib, Lenalidomide and Dexamethasone (KRd) Therapy -  28 day

Regimen

00405a

Carfilzomib,  lenalidomide and dexamethasone therapy is indicated  for the treatment of adult patients with multiple myeloma who have received at least one prior therapy

Chlorambucil 10mg/m2 Therapy

Regimen

00411a

Treatment of patients with low grade lymphoma.

CyBorD/ Cylophosphamide, Bortezomib, and Dexamethasone-21 day Therapy

Regimen

00273a

Treatment of newly diagnosed symptomatic multiple myeloma*

00273b

Treatment of relapsed/refractory multiple myeloma*

Daratumumab Monotherapy

Regimen

00426a

As monotherapy for the treatment of adult patients with relapsed and refractory multiple myeloma whose prior therapy included a proteasome inhibitor and an immunomodulatory agent and who have demonstrated disease progression on the last therapy.

Dose Adjusted R-EPOCH Therapy

Regimen

00355a

Treatment of patients with CD20 positive diffuse large B-cell Non Hodgkins lymphoma (NHL).

Escalated Dose BEACOPP 21 day Therapy

Regimen

00354a

 Treatment of patients with high risk, advanced stage Hodgkin Lymphoma (IPS ≥ 3)

 00354b

Escalation of treatment of patients with Hodgkin Lymphoma after failure to reach complete metabolic response post 2 cycles of ABVD

Dexamethasone, riTUXimab and Cyclophosphamide (DRC) Therapy

Regimen

00532a

Treatment of symptomatic treatment naive or relapsed/refractory Waldenstrom’s macroglobulinaemia

Lenalidomide 25mg and Dexamethasone Therapy-28 day

Regimen

00218a

Treatment of adult patients with previously untreated multiple myeloma who are not eligible for transplant.

00218b

Treatment of multiple myeloma in adult patients who have received at least one prior therapy.

High dose Methotrexate, high dose Cytarabine, riTUXimab and Thiotepa (MATRix)Therapy

Regimen

00508a

Treatment of primary CNS lymphoma

00508b

Treatment of CNS relapse of a high grade systemic lymphoma

Modified CyBord/ Bortezomib/ Cyclophosphamide and Dexamethasone – weekly therapy

Regimen

00299a

Treatment of newly diagnosed symptomatic multiple myeloma.

00299b

Treatment of relapsed/refractory multiple myeloma.

Brentuximab vedotin Monotherapy

Regimen

Treatment of adult patients with relapsed or refractory CD30+ Hodgkin lymphoma (HL):

00234a

Following autologous stem cell transplant (ASCT)

or

00234b

Following at least two prior therapies when ASCT or multi-agent chemotherapy is not a treatment option

00234c

Treatment of adult patients with relapsed or refractory systemic anaplastic large cell lymphoma (sALCL)

CHOEP Therapy-21 days

Regimen

00396a

Treatment of T-cell Non-Hodgkins Lymphoma.

Cladribine 5 day and riTUXimab Therapy

Regimen

00531a

Treatment for adult patients with relapsed or partially responsive  Hairy Cell Leukaemia

Cladribine Weekly and riTUXimab Therapy

Regimen

00534a

Treatment for adult patients with relapsed or partially responsive  Hairy Cell 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

Cyclophosphamide 2000mg/m2 For Stem Cell Mobilisation

Regimen

00438a

Mobilisation of peripheral blood stem cells for future stem cell rescue following high dose chemotherapy

Ibrutinib Therapy (Mantle Cell Lymphoma)

Regimen

00297a

As a single agent for the treatment of adult patients with relapsed or refractory mantle cell lymphoma (MCL).

Idelalisib Monotherapy

Regimen

00291a

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

Ixazomib, Lenalidomide and Dexamethasone Therapy -  28 day

Regimen

00516a

Ixazomib in combination with lenalidomide and dexamethasone for the treatment of adult patients with multiple myeloma who have received at least one prior therapy

High Dose Melphalan Conditioning Therapy for Autologous Stem Cell Transplant

Regimen

00454a 

Conditioning Therapy in patients with Multiple Myeloma prior to autologous stem cell transplant 

00454b

Conditioning Therapy in patients with other plasma cell dyscrasia such as AL amyloidosis

Nivolumab 240mg Monotherapy

Regimen

00483c

As monotherapy is indicated for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma (cHL) after autologous stem cell transplant (ASCT) and treatment with brentuximab vedotin.

Nordic Therapy Protocol

Regimen

00393a

Mantle Cell Lymphoma.

Obinutuzumab and Bendamustine Therapy

Regimen

00424a

Obinutuzumab in combination with bendamustine is indicated for the treatment of patients with follicular lymphoma (FL) who did not respond or who progressed during or up to 6 months after treatment with rituximab or a rituximab-containing regimen.

00424B

Obinutuzumab in combination with bendamustine is indicated for the treatment of patients with previously untreated advanced follicular lymphoma.

Obinutuzumab Maintenance Therapy - 56 day

Regimen

00425a

Obinutuzumab maintenance therapy is indicated in patients with follicular lymphoma (FL) who have responded to induction treatment with obinutuzumab and chemotherapy (CHOP, CVP or bendamustine) or have stable disease.

Obinutuzumab Cyclophosphamide VinCRIStine and Prednisolone (O- CVP) Therapy– 21 days

Regimen

00550a

Obinutuzumab in combination with CVP chemotherapy is indicated for the treatment of patients with previously untreated advanced follicular lymphoma.

Obinutuzumab and CHOP Therapy – 21 day

Regimen

00549a

Obinutuzumab in combination with CHOP chemotherapy is indicated for the treatment of patients with previously untreated advanced follicular lymphoma.

Pembrolizumab 200mg Monotherapy

Regimen

00455d

As monotherapy for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma (cHL) who are transplant-ineligible and have failed brentuximab vedotin

Pembrolizumab 400mg monotherapy

Regimen

00558d

As monotherapy for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma (cHL) who are transplant-ineligible and have failed brentuximab vedotin

Pixantrone Therapy

Regimen

00255a

Monotherapy for the treatment of adult patients with multiply relapsed or refractory aggressive Non-Hodgkin B-cell Lymphomas (NHL).

The benefit of pixantrone treatment has not been established in patients when used as fifth line or greater chemotherapy in patients who are refractory to last therapy.

Plerixafor and G-CSF Therapy

Regimen

00536a

Is indicated in combination with granulocyte-colony stimulating factor (G-CSF) to enhance mobilisation of haematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in adult patients with lymphoma and multiple myeloma whose cells mobilise poorly 

Pomalidomide and Dexamethasone

Regimen

00245a

Treatment in combination with dexamethasone of adult patients with relapsed and refractory multiple myeloma who have received at least two prior treatment regimens, including both lenalidomide and bortezomib, and have demonstrated disease progression on the last therapy.

RiTUXimab 375 mg/m2 Maintenance Therapy-84 day

Regimen

00540a

Maintenance therapy for the treatment of relapsed/refractory follicular CD20
positive, B-cell Non Hodgkin Lymphoma (NHL) in patients who have
responded to induction therapy

RiTUXimab 375 mg/m2 Therapy-7 day

Regimen

00541a

First line treatment of follicular lymphoma

00541b

As monotherapy for induction treatment for adult patients with stage
III-IV follicular lymphoma who are chemoresistant or are in their second
or subsequent relapse after chemotherapy

00541c

As monotherapy for retreatment of patients who have responded to
previous treatment with riTUXimab monotherapy for
relapsed/refractory follicular lymphoma,

riTUXimab 375 mg/m2 Combination Therapy-21 day

Regimen

00542a

In combination with chemotherapy for induction treatment of
previously untreated or relapsed/ refractory CD 20 positive patients
with follicular lymphoma

RiTUXimab 375 mg/m2 Maintenance Therapy- 56 day

Regimen

00543a

Maintenance therapy for the treatment of previously untreated follicular
CD20 positive, B-cell Non Hodgkin Lymphoma patients responding to
induction therapy

riTUXimab and Bendamustine Therapy

Regimen

00345a

Treatment of patients with previously untreated indolent CD20-positive, stage III-IV non-hodgkin lymphoma (NHL).

00345b

Treatment of patients with previously untreated CD20-positive, stage III-IV mantle cell lymphoma (MCL), ineligible for autologous stem cell transplant.

R-CEOP Therapy

Regimen

00510a

Treatment of Non Hodgkin CD20 positive Lymphoma for patients not suitable for anthracycline therapy

(*riTUXimab) Cyclophosphamide, DOXOrubicin, vinCRIStine and Prednisolone (*R)-CHOP Therapy– 14 days

Regimen

00409a

Treatment of Non Hodgkins Lymphoma (NHL)*

*Rituximab to be included in CD20 positive patients

(*Rituximab) Cyclophosphamide, DOXOrubicin, VinCRIStine and Prednisolone (*R)-CHOP) Therapy– 21 days

Regimen

00307a

Treatment of Non Hodgkins Lymphoma (NHL).*

*Rituximab to be included in CD20 positive patients.

(R**)- miniCHOP Therapy – 21 days

Regimen

00436a

Treatment of Non Hodgkin Lymphoma in patients aged greater than 80 or with significant co-morbidities.

R-CODOX-M Therapy Patients less than or equal to 65 years

Regimen

00398a

Treatment of Burkitt Lymphoma in patients less than or equal to 65 years.

R-CODOX-M Therapy Patients greater than 65 years

Regimen

00403a

Treatment of Burkitt Lymphoma in patients aged greater than 65 years.

(R**)-DHAP Therapy

Regimen

00395a

Treatment of relapsed Non Hodgkin Lymphoma**

**Rituximab to be included in CD20 positive patients

00395b

Treatment of relapsed Hodgkins Lymphoma

(R**)-ESHAP Therapy

Regimen

00394a

Treatment of relapsed Non Hodgkin Lymphoma

00394b

Treatment of relapsed Hodgkins Lymphoma

riTUXimab** Gemcitabine and CISplatin ((R**)-GDP) Therapy

Regimen

00441a

Treatment of relapsed Non Hodgkin Lymphoma

00441b

Treatment of relapsed Hodgkin’s 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.

riTUXimab-Hyper CVAD Therapy (MCL)-Part A

Regimen

00466a

Treatment of adult patients with mantle cell lymphoma

riTUXimab-Methotrexate and Cytarabine Therapy (MCL-Hyper CVAD Part B

Regimen

00467a

Treatment of adult patients with mantle cell lymphoma

 (R**)-ICE ((RiTUXimab), Ifosfamide, CARBOplatin and Etoposide) Therapy

Regimen

00397a

Treatment of relapsed/refractory Non Hodgkin’s Lymphoma**

**Rituximab to be included in CD20 positive patients.

00397b

Treatment of relapsed/refractory Hodgkin’s Lymphoma.

R-IVAC Therapy Patients less than or equal to 65 years

Regimen

00399a

Treatment of patients with extensive stage  Burkitt Lymphoma aged less than or equal to 65 years.

R-IVAC Therapy Patients greater than 65 years

Regimen

00404a

Treatment of patients with extensive Burkitt Lymphoma aged greater than  65 years.

(*riTUXimab) Cyclophosphamide and PrednisoLONE (R*)-CVP ) Therapy-21 days

Regimen

00293a

First line treatment for patients with stage 3/4 follicular lymphoma

00293b

Treatment of patients with relapsed/refractory low grade B cell Non Hodgkin’s lymphoma (NHL)*

*Rituximab to be included in CD20 positive patients.

Siltuximab Monotherapy

Regimen

00277a

Treatment of adult patients with Multicentric Castleman’s disease (MCD) who are human immunodeficiency virus (HIV) negative and human herpes virus 8 (HHV-8) negative.

SMILE Therapy (NK or T cell Lymphoma)

Regimen

00407a

Newly diagnosed stage II- IV or relapsed/refractory extranodal natural killer/T-cell lymphoma

LEAM Autologous Transplant Conditioning Protocol

Regimen

00468a

Autologous conditioning in non-Hodgkins Lymphoma (NHL)

00468b

Autologous conditioning in Hodgkins Lymphoma