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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 8 - Malignant disease and immunosuppression 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
08.01.01 Alkylating drugs

Bendamustine

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.
25mg & 100mg Injection
unlicensedunlicensed 110mg - 240mg in 0.9% Sodium Chloride Infusion (500mL)

Restricted for use iin accordance with the following NICE TA(s):-

BNF BNFc SPC
DSU July 2017: Bendamustine (Levact): increased mortality observed in recent clinical studies in off-label use; monitor for opportunistic infections, hepatitis B reactivation NICE TA 649 Polatuzumab vedotin with rituximab and bendamustine for treating relapsed or refractory diffuse large B-cell lymphoma NICE TA216: Bendamustine for CLL

Busulfan

RED
Restricted Drug Restricted
2mg Tablets

BNF BNFc SPC

Carmustine (Gliadel®)
(Implant)

RED
Restricted Drug Restricted
FOR ALL PRESCRIBING – Blueteq or High cost drug form required – see link from Formulary homepage.
For use according to NICE TA121

Currently not commissioned at the L&D
BNF BNFc SPC
NICE TA121: Glioma (newly diagnosed and high grade) - carmustine implants and temozolomide

Chlorambucil

RED
Restricted Drug Restricted
2mg Tablets

BNF BNFc SPC

Chlormethine (Ledaga® )
(160 micrograms/g gel)

RED
Restricted Drug Restricted

RESTRICTED FOR ALL PRESCRIBING - Blueteq or High cost drug form required - see link from Formulary homepage.

For use in accordance with the following NICE TA(s) only:-

Tertiary care initiation.

BNF BNFc SPC BlueTeq
NICE TA720 Chlormethine gel for treating mycosis fungoides-type cutaneous T-cell lymphoma

Cyclophosphamide

RED
Restricted Drug Restricted
50mg Tablets

BNF BNFc SPC

Melphalan

RED
Restricted Drug Restricted
50mg Injection

BNF BNFc SPC

Treosulfan (Trecondi®)
(1g and 5g Powder for Solution for Infusion)

RED
Restricted Drug Restricted

FOR ALL PRESCRIBING - Blueteq or High cost drug form required - see link from Formulary homepage

Restricted for use in accordance with the following NICE Ta (s):-

BNF BNFc SPC
NICE TA640: Treosulfan with fludarabine for malignant disease before allogeneic stem cell transplant NICE TA945: Treosulfan with fludarabine before allogeneic stem cell transplant for people aged 1 month to 17 years with non-malignant diseases (terminated appraisal)
Non formulary items

Melphalan flufenamide (Pepaxti®) (20 mg powder for concentrate for solution for infusion)

DNP
Non Formulary
BNF BNFc SPC
NICE TA968: Melphalan flufenamide with dexamethasone for treating relapsed or refractory multiple myeloma (terminated appraisal)
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.