TREANDA (bendamustine)
OFFICE ADMINISTERED
Indication(s) for Prior Authorization:
- Chronic lymphocytic leukemia (CLL)
- (Classical) Hodgkin Lymphoma, refractory/relapsed
- Multiple Myeloma, refractory/relapsed
- Non-Hodgkin’s lymphoma
- Waldenstrom’s macroglobulinemia/lymphoplasmacytic lymphoma
Patients must meet all the following criteria for the indication above:
Chronic lymphocytic leukemia (CLL)
- First line therapy with or without rituximab for stage II-IV disease OR
- With or without rituximab for relapsed or refractory disease
Hodgkin Lymphoma, refractory/relapsed
- Diagnosis of refractory or relapsed Hodgkin Lymphoma
- Third line therapy, failure of two prior chemotherapeutic regimens
Multiple Myeloma, refractory/relapsed
- Diagnosis of refractory or relapsed Multiple Myeloma
Non-Hodgkin’s lymphoma, subtypes as listed
- Aids-related B-cell lymphoma
- Diffuse large B-cell lymphoma
- Follicular lymphoma
- Gastric MALT lymphoma
- Mantle Cell Lymphoma
- Non-Gastric MALT lymphoma
- Primary cutaneous B-Cell Lymphoma
- Splenic marginal zone lymphoma
- Indolent B-cell lymphoma
Indolent B-cell lymphoma
- That has progressed during or within six months of treatment with rituximab or a rituximab containing regimen
Waldenstrom’s macroglobulinarmia/lyphoplasmacytic lymphoma
- Diagnosis of Waldenstrom’s macroglobulinarmia/lyphoplasmacytic lymphoma
The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:
- Disease states not listed above
Dosing:
Chronic lymphocytic leukemia (CLL)
- Up to 100 mg/m2 IV infusion on days 1 and 2 of each 28 day cycle.
Hodgkin Lymphoma, refractory/relapsed
- Up to 120mg/m2 IV infusion on days 1 and 2 of each 28 day cycle.
Multiple Myeloma, refractory/relapsed
- Up to 100 mg/m2 IV infusion on days 1 and 2 of each 28 day cycle.
Non-Hodgkin’s lymphoma, any subtype listed above
- Up to 120mg/m2 IV infusion on days 1 and 2 of each 21 day cycle.
Waldenstrom’s macroglobulinarmia/lyphoplasmacytic lymphoma
- Up to 90 mg/m2 IV infusion on days 1 and 2 (or days 2 and 3) of each 28 day cycle, total dose/cycle = 180mg/m2 OR
- Up to 90 mg/m2 IV infusion on days 8 and 9, 36 and 37, 64 and 65, 92 and 93, total dose = 720mg/m2
Last review date: December 1, 2014