Blood and bone marrow cancers

Short Text

This pathway covers blood and bone marrow cancers, including leukaemia, lymphoma and myeloma.

Introduction

This pathway covers blood and bone marrow cancers, including leukaemia, lymphoma and myeloma.
NICE is developing guidance on non-Hodgkin's lymphoma, which is expected to be published in December 2015 and multiple myeloma, which is expected to be published in January 2016.
To find other information about blood and bone marrow cancers, including evidence from NICE Accredited sources, visit NICE Evidence Search.

Source guidance

The NICE guidance that was used to create the pathway.
Bortezomib monotherapy for relapsed multiple myeloma. NICE technology appraisal 129 (2007)
Rituximab for aggressive non-Hodgkin's lymphoma. NICE technology appraisal 65 (2003)

Quality standards

Quality statements

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Pathway information

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Updates to this pathway

14 March 2014 Minor maintenance update.
25 February 2014
Pixantrone monotherapy for treating multiply relapsed or refractory aggressive non-Hodgkin's B-cell lymphoma (NICE technology appraisal guidance 306) added to the lymphoma path
20 February 2014 Amended position of TA218 on the leukaemia path
27 January 2014 Minor maintenance updates

Supporting information

Glossary

Person with lymphoma

Person with lymphoma

Non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma

NICE is producing a clinical guideline on non-Hodgkin's lymphoma: diagnosis and management of non-Hodgkin's lymphoma, which is publishing in December 2015.
The appraisal of Bendamustine for the treatment of indolent (low grade) non-Hodgkin's lymphoma that is refractory to rituximab (NICE technology appraisal 206) was terminated because no evidence submission was received from the manufacturer or sponsor of the technology. Therefore NICE is unable to make a recommendation about the use in the NHS of bendamustine for treating indolent (low grade) non-Hodgkin's lymphoma that is refractory to rituximab.

Source guidance

First-line and maintenance treatment and induction of remission (rituximab)

First-line and maintenance treatment and induction of remission (rituximab)

First-line and maintenance treatment and induction of remission (rituximab)

First line treatment for non-Hodgkin's lymphoma

Rituximab is recommended for use in combination with a regimen of cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) for the first-line treatment of people with CD20-positive diffuse large-B-cell lymphoma at clinical stage II, III or IV (see section 2.3 in NICE technology appraisal guidance 65). Rituximab is not recommended for use when CHOP is contraindicated.
The clinical and cost effectiveness of rituximab in patients with localised disease (Stage I, see Section 2.3 in NICE technology appraisal guidance 65) has not been established. It is recommended that rituximab be used in these circumstances only as part of ongoing or new clinical studies.
A specialist in the treatment of lymphomas should supervise the use of rituximab in combination with CHOP for the treatment of diffuse large-B-cell lymphoma.
These recommendations are from rituximab for aggressive non-Hodgkin's lymphoma (NICE technology appraisal guidance 65).
NICE has written (information for the public explaining its guidance on first-line rituximab for aggressive non-Hodgkin's lymphoma.

First-line treatment for stage III or IV follicular non-Hodgkin's lymphoma

Rituximab, in combination with:
  • cyclophosphamide, vincristine and prednisolone (CVP)
  • cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP)
  • mitoxantrone, chlorambucil and prednisolone (MCP)
  • cyclophosphamide, doxorubicin, etoposide, prednisolone and interferon-a (CHVPi) or
  • chlorambucil
is recommended as an option for the treatment of symptomatic stage III and IV follicular lymphoma in previously untreated people.
NICE has written information for the public explaining its guidance on first-line rituximab for stage III-IV follicular lymphoma.

Maintenance treatment for follicular non-Hodgkin's lymphoma

Rituximab maintenance therapy is recommended as an option for the treatment of people with follicular non-Hodgkin's lymphoma that has responded to first-line induction therapy with rituximab in combination with chemotherapy.
This recommendation is from rituximab for the first-line maintenance treatment of follicular non-Hodgkin's lymphoma (NICE technology appraisal guidance 226).
NICE has written information for the public explaining its guidance on first-line rituximab for maintenance treatment of follicular non-Hodgkin's lymphoma.

Induction of remission for relapsed/refractory stage III or IV follicular non-Hodgkin's lymphoma

Rituximab, within its marketing authorisation, in combination with chemotherapy, is recommended as an option for the induction of remission in people with relapsed stage III or IV follicular non-Hodgkin's lymphoma.
Rituximab monotherapy as maintenance therapy, within its marketing authorisation, is recommended as an option for the treatment of people with relapsed stage III or IV follicular non-Hodgkin's lymphoma in remission induced with chemotherapy with or without rituximab.
Rituximab monotherapy, within its marketing authorisation, is recommended as an option for the treatment of people with relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma, when all alternative treatment options have been exhausted (that is, if there is resistance to or intolerance of chemotherapy).
NICE has written information for the public explaining its guidance on rituximab for relapsed or refractory stage III or IV follicular non-Hodgkin's lymphoma.

Source guidance

Multiply relapsed or refractory aggressive non-Hodgkin's B-cell lymphoma (pixantrone)

Multiply relapsed or refractory aggressive non-Hodgkin's B-cell lymphoma (pixantrone)

Multiply relapsed or refractory aggressive non-Hodgkin's B-cell lymphoma (pixantrone)

Pixantrone monotherapy is recommended as an option for treating adults with multiply relapsed or refractory aggressive non-Hodgkin's B-cell lymphoma only if:
  • the person has previously been treated with rituximab and
  • the person is receiving third- or fourth-line treatment and
  • the manufacturer provides pixantrone with the discount agreed in the patient access scheme.
People currently receiving treatment initiated within the NHS with pixantrone monotherapy that is not recommended for them by NICE in this guidance should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.
These recommendations are from pixantrone monotherapy for treating multiply relapsed or refractory aggressive non-Hodgkin's B-cell lymphoma (NICE technology appraisal guidance 306).
NICE has written information for the public explaining its guidance on pixantrone.

Implementation tools

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Source guidance

Mantle cell lymphoma

Mantle cell lymphoma

Mantle cell lymphoma

The appraisal of Temsirolimus for the treatment of relapsed or refractory mantle cell lymphoma (NICE technology appraisal 207) was terminated because no evidence submission was received from the manufacturer or sponsor of the technology. Therefore NICE is unable to make a recommendation about the use in the NHS of temsirolimus for treating relapsed or refractory mantle cell lymphoma.

Source guidance

Paths in this pathway

Pathway created: December 2013 Last updated: March 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.



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