Lymphoma SACT 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.

For information on open clinical trials please refer to the Cancer Trials Ireland website here and also to basket trials here.

Lymphoma Chemotherapy Regimens

Regimen Name Indication

ABVD Therapy

Regimen

00290a

Hodgkin’s Lymphoma.

Bendamustine Monotherapy

Regimen

00527a

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

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)

00234d

Treatment of adult patients with CD30+ cutaneous T-cell lymphoma (CTCL) after at least 1 prior systemic therapy.

00234e

Treatment of adult patients with CD30+ Hodgkins Lymphoma (HL) at increased risk of relapse or progression following an autologous haematopoietic stem cell transplant (ASCT).

Brentuximab vedotin and Bendamustine Therapy*

Regimen

00529a

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

Brentuximab vedotin, Etoposide, methylPREDNISolone, Cytarabine and CISplatin, (ESHAP) therapy (BRESHAP)

Regimen

00530a

Treatment of adult patients with relapsed/refractory CD30+ Hodgkin’s lymphoma.

Brentuximab vedotin and cycloPHOSphamide, DOXOrubicin and prednisoLONE (CHP) Therapy

Regimen

00801a

Brentuximab vedotin in combination with cyclophosphamide, DOXOrubicin and prednisoLONE (CHP) for use in adult patients with previously untreated systemic anaplastic large cell lymphoma (sALCL)

Brentuximab vedotin and ICE Therapy*

Regimen

00528

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

Chlorambucil 10mg/m2 Therapy

Regimen

00411a

Treatment of patients with low grade lymphoma.

CHOEP Therapy-21 days

Regimen

00396a

Treatment of T-cell non-Hodgkin's 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

cycloPHOSphamide 1500mg/m2 For Stem Cell Mobilisation

Regimen

00795a

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

cycloPHOSphamide, DOXOrubicin, vinCRIStine and prednisoLONE (CHOP) Therapy– 21 days

Regimen

00841a

Treatment of non-Hodgkin's lymphoma (NHL)

Dexamethasone, riTUXimab and Cyclophosphamide (DRC) Therapy

Regimen

00532a

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

Dose Adjusted riTUXimab, Etoposide, prednisoLONE, DOXOrubicin, cycloPHOSphamide and vinCRIStine (DA-R EPOCH)  

Regimen

00355a

Treatment of patients with CD20 positive diffuse large B-cell non-Hodgkin's lymphoma (NHL).

Dose Adjusted riTUXimab S/C, Etoposide, prednisoLONE, DOXOrubicin, cycloPHOSphamide and vinCRIStine (DA-R(S/C) EPOCH) Therapy

Regimen

 00672a

Treatment of patients with CD20 positive diffuse large B-cell non-Hodgkin’s lymphoma (NHL)

ESHAP Therapy

Regimen

00838a

Treatment of relapsed non-Hodgkin's Lymphoma

00838b

Treatment of relapsed Hodgkins Lymphoma

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

Escalated Dose BEACOPDAC 21 Day Therapy

Regimen

00837a

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

00837b

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

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.

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.

Mogamulizumab Therapy

Regimen

00761a

As monotherapy for the treatment of adult patients with mycosis fungoides (MF) or Sézary syndrome (SS) who have received at least one prior systemic 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

Nivolumab 240mg Monotherapy - 14 Day

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.

Nivolumab 480mg-28days

Regimen

00484d

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 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 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 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, cycloPHOSphamide, DOXOrubicin, vinCRIStine and prednisoLONE (O-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

00455i

As monotherapy for the treatment of adult patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL) who have failed autologous stem cell transplant (ASCT) or following at least two prior therapies when ASCT is not a treatment option.

Pembrolizumab 400mg monotherapy

Regimen

00558i

As monotherapy for the treatment of adult patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (cHL) who have failed autologous stem cell transplant (ASCT) or following at least two prior therapies when ASCT is not a treatment option.

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 

Polatuzumab Vedotin, Bendamustine and riTUXimab Therapy

Regimen

00685a

Polatuzumab Vedotin in combination with bendamustine and riTUXimab for the treatment of adult patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who are not candidates for haematopoietic stem cell transplant

Polatuzumab Vedotin, riTUXimab, cycloPHOSphamide, DOXOrubicin and prednisoLONE Therapy

Regimen

00833a

Polatuzumab Vedotin in combination with riTUXimab, cycloPHOSphamide, DOXOrubicin and prednisoLONE for the treatment of adult patients with previously untreated diffuse large B-cell lymphoma (DLBCL)

riTUXimab, Methotrexate, Procarbazine and vinCRIStine (R-MPV) – 14 Days Induction Therapy

Regimen

00664a

Treatment of newly diagnosed primary CNS lymphoma (PCNSL)

High Dose Cytarabine Consolidation Therapy (post RMPV) - 28 day Therapy

Regimen

00666a

Consolidation chemotherapy for the treatment of patients with newly diagnosed primary CNS lymphoma (PCNSL)

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's 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 (S/C 1400mg) Maintenance Therapy-84 day

Regimen

00599a

Maintenance therapy for the treatment of relapsed/refractory follicular CD20 positive, B-cell non-Hodgkin's lymphoma (NHL) in patients who have responded to induction therapy.

RiTUXimab (S/C 1400mg) Maintenance Therapy- 56 day

Regimen

00600a

Maintenance therapy for the treatment of previously untreated follicular CD20 positive, B-cell non-Hodgkin's 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's 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's 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-Hodgkin's 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-Hodgkin's lymphoma (NHL).*

*riTUXimab to be included in CD20 positive patients.

riTUXimab S/C, cycloPHOSphamide, DOXOrubicin, vinCRIStine and prednisoLONE (R-CHOP) Therapy – 21 Days

Regimen

00667a

Treatment of non-Hodgkin’s lymphoma (NHL)

(R**)- miniCHOP Therapy – 21 days

Regimen

00436a

Treatment of non-Hodgkin's lymphoma in patients aged greater than 80 or with significant co-morbidities.

* riTUXimab to be included in all CD20 positive patients.

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*)-ICE ((riTUXimab*), Ifosfamide, CARBOplatin and Etoposide) Therapy - Outpatient

Regimen

00751a

Treatment of relapsed/refractory non-Hodgkin’s lymphoma (NHL)*

00751b

Treatment of relapsed/refractory Hodgkin’s lymphoma (HL)

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's 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's lymphoma

00394b

Treatment of relapsed Hodgkins Lymphoma

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

Regimen

00441a

Treatment of relapsed non-Hodgkin's 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.

ICE (Ifosfamide, CARBOplatin and Etoposide) Therapy

Regimen

00842a

Treatment of relapsed/refractory non-Hodgkin’s Lymphoma

00842b

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.

(*riTUXimab)-Gemcitabine Cyclophosphamide vinCRIStine and PrednisoLONE (*R)-GCVP) Therapy–21 days

Regimen

00737a

Treatment of high-grade non-Hodgkin Lymphoma in patients who are unsuitable for R-CHOP due to impaired cardiac function or other comorbidities*

*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

Zanubrutinib Therapy

Regimen

00708a

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

708b

As monotherapy for the treatment of adult patients with chronic lymphocytic leukaemia (CLL), who are treatment naïve and have del(17p) and/or TP53-mutated disease

708c

As monotherapy for the treatment of adult patients with CLL, who have relapsed and/or refractory disease following at least one line of prior therapy

  * Unlicensed indication. See protocol for more details.