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Drug overview for CARMUSTINE (carmustine):
Generic name: carmustine (kar-MUS-teen)
Drug class: Nitrosoureas
Therapeutic class: Antineoplastics
Carmustine, a nitrosourea-derivative alkylating agent, is an antineoplastic agent.
No enhanced Uses information available for this drug.
Generic name: carmustine (kar-MUS-teen)
Drug class: Nitrosoureas
Therapeutic class: Antineoplastics
Carmustine, a nitrosourea-derivative alkylating agent, is an antineoplastic agent.
No enhanced Uses information available for this drug.
DRUG IMAGES
CARMUSTINE 100 MG VIAL
The following indications for CARMUSTINE (carmustine) have been approved by the FDA:
Indications:
Anaplastic astrocytoma
Glioblastoma multiforme
Hodgkin's lymphoma
Malignant brain neoplasm
Malignant glioma
Multiple myeloma
Non-Hodgkin's lymphoma
Professional Synonyms:
Anemia lymphatica
Brain cancer
Brain malignancy
Grade III astrocytoma
Grade IV astrocytoma
Hodgkin's disease
Malignant astrocytoma
Malignant glial tumor
Malignant gliocytoma
Malignant neoplasm of brain
Malignant neurogliocytoma
Malignant neuroglioma
Malignant neurospongioma
Malignant tumor of brain
Non-Hodgkin's type lymphoma
Plasma cell myeloma
Indications:
Anaplastic astrocytoma
Glioblastoma multiforme
Hodgkin's lymphoma
Malignant brain neoplasm
Malignant glioma
Multiple myeloma
Non-Hodgkin's lymphoma
Professional Synonyms:
Anemia lymphatica
Brain cancer
Brain malignancy
Grade III astrocytoma
Grade IV astrocytoma
Hodgkin's disease
Malignant astrocytoma
Malignant glial tumor
Malignant gliocytoma
Malignant neoplasm of brain
Malignant neurogliocytoma
Malignant neuroglioma
Malignant neurospongioma
Malignant tumor of brain
Non-Hodgkin's type lymphoma
Plasma cell myeloma
The following dosing information is available for CARMUSTINE (carmustine):
No enhanced Dosing information available for this drug.
No enhanced Administration information available for this drug.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for CARMUSTINE (carmustine):
There are 5 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Efalizumab; Natalizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Natalizumab,(1-3) efalizumab,(4) immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of natalizumab(1-3) or efalizumab(4) with immunosuppressives or immunomodulators may result in an increased risk of infections, including progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV). PREDISPOSING FACTORS: Previous JCV infection, longer duration of natalizumab treatment - especially if greater than 2 years, and prior or concomitant treatment with immunosuppressant medication are all independent risk factors which increase the risk for PML.(1,5) The FDA has estimated PML incidence stratified by risk factors: If anti-JCV antibody positive, no prior immunosuppressant use and natalizumab treatment less than 25 months, incidence <1/1,000. If anti-JCV antibody positive, history of prior immunosuppressant use and natalizumab treatment less than 25 months, incidence 2/1,000 If anti-JCV antibody positive, no prior immunosuppressant use and natalizumab treatment 25-48 months, incidence 4/1,000 If anti-JCV antibody positive, history of prior immunosuppressant use and natalizumab treatment 25-48 months, incidence 11/1,000. PATIENT MANAGEMENT: The US manufacturer of natalizumab states patients with Crohn's disease should not receive concurrent immunosuppressants, with the exception of limited overlap of corticosteroids, due to the increased risk for PML. For new natalizumab patients currently receiving chronic oral corticosteroids for Crohn's Disease, begin corticosteroid taper when therapeutic response to natalizumab has occurred. If corticosteroids cannot be discontinued within six months of starting natalizumab, discontinue natalizumab.(3) The US manufacturer of natalizumab states that natalizumab should not ordinarily be used in multiple sclerosis patients receiving immunosuppressants or immunomodulators due to the increased risk for PML. Immunosuppressives include, but are not limited to azathioprine, cyclophosphamide, cyclosporine, mercaptopurine, methotrexate, mitoxantrone, mycophenolate, and corticosteroids.(3,6) The UK manufacturer of natalizumab states that concurrent use with immunosuppressives or antineoplastic agents is contraindicated.(1) The Canadian manufacturer of natalizumab states that natalizumab should not be used with immunosuppressive or immunomodulatory agents.(2) The US manufacturer of certolizumab states that concurrent therapy with natalizumab is not recommended.(7) DISCUSSION: Progressive multifocal leukoencephalopathy has been reported in patients receiving concurrent natalizumab were recently or concomitantly taking immunomodulators or immunosuppressants.(1-5,8,9) In a retrospective cohort study of multiple sclerosis patients newly initiated on a disease-modifying therapy, use of high-efficacy agents (alemtuzumab, natalizumab, or ocrelizumab) resulted in the same risk of overall infections as moderate-efficacy agents, but there was an elevated risk of serious infections (adjusted hazard ratio [aHR] = 1.24, 95% confidence interval (CI) = 1.06-1.44) and UTIs (aHR = 1.21, 95% CI = 1.14-1.30).(10) |
TYSABRI |
| Alkylating Agents/Nalidixic Acid SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The exact mechanism is unknown. CLINICAL EFFECTS: Concurrent use of nalidixic acid in patients undergoing therapy with an alkylating agent may result in serious gastrointestinal toxicity such as hemorrhagic ulcerative colitis or intestinal necrosis.(1-2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of nalidixic acid states that the concurrent use of nalidixic acid with an alkylating agent is contraindicated.(1) The manufacturer of intravenous melphalan states that when given simultaneously with nalidixic acid, the incidence of severe hemorrhagic necrotic enterocolitis has been reported to increase in pediatric patients.(2) DISCUSSION: Concurrent use of nalidixic acid in patients undergoing therapy with may result in serious gastrointestinal toxicity such as hemorrhagic ulcerative colitis or intestinal necrosis.(1,2) Therefore, the manufacturer of nalidixic acid states that the concurrent use of nalidixic acid with an alkylating agent is contraindicated.(1) |
NALIDIXIC ACID |
| Live Vaccines; Live BCG/Selected Immunosuppressive Agents SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: A variety of disease modifying agents suppress the immune system. Immunocompromised patients may be at increased risk for uninhibited replication after administration of live, attenuated vaccines or intravesicular BCG. Immune response to vaccines may be decreased during periods of immunocompromise.(1) CLINICAL EFFECTS: The expected serum antibody response may not be obtained and/or the vaccine may result in illness.(1) After instillation of intravesicular BCG, immunosuppression may interfere with local immune response, or increase the severity of mycobacterial infection following inadvertent systemic exposure.(2) PREDISPOSING FACTORS: Immunosuppressive diseases (e.g. hematologic malignancies, HIV disease), treatments (e.g. radiation) and drugs may all increase the magnitude of immunodeficiency. PATIENT MANAGEMENT: The Centers for Disease Control(CDC) Advisory Committee on Immunization Practices (ACIP) states that live-virus and live, attenuated vaccines should not be administered to patients who are immunocompromised. The magnitude of immunocompromise and associated risks should be determined by a physician.(1) For patients scheduled to receive chemotherapy, vaccination should ideally precede the initiation of chemotherapy by 14 days. Patients vaccinated while on immunosuppressive therapy or in the 2 weeks prior to starting therapy should be considered unimmunized and should be revaccinated at least 3 months after discontinuation of therapy.(1) Patients who receive anti-B cell therapies should not receive live vaccines for at least 6 months after such therapies due to a prolonged duration of immunosuppression. An exception is the Zoster vaccine, which can be given at least 1 month after receipt of anti-B cell therapies.(1) The US manufacturer of abatacept states live vaccines should not be given during or for up to 3 months after discontinuation of abatacept.(2) The US manufacturer of live BCG for intravesicular treatment of bladder cancer states use is contraindicated in immunosuppressed patients.(3) The US manufacturer of daclizumab states live vaccines are not recommended during and for up to 4 months after discontinuation of treatment.(4) The US manufacturer of guselkumab states that live vaccines should be avoided during treatment with guselkumab.(5) The US manufacturer of inebilizumab-cdon states that live vaccines are not recommended during treatment and after discontinuation until B-cell repletion. Administer all live vaccinations at least 4 weeks prior to initiation of inebilizumab-cdon.(6) The US manufacturer of ocrelizumab states that live vaccines are not recommended during treatment and until B-cell repletion occurs after discontinuation of therapy. Administer all live vaccines at least 4 weeks prior to initiation of ocrelizumab.(7) The US manufacturer of ozanimod states that live vaccines should be avoided during and for up to 3 months after discontinuation of ozanimod.(8) The US manufacturer of siponimod states that live vaccines are not recommended during treatment and for up to 4 weeks after discontinuation of treatment.(9) The US manufacturer of ustekinumab states BCG vaccines should not be given in the year prior to, during, or the year after ustekinumab therapy.(10) The US manufacturer of satralizumab-mwge states that live vaccines are not recommended during treatment and should be administered at least four weeks prior to initiation of satralizumab-mwge.(11) The US manufacturer of ublituximab-xiiy states that live vaccines are not recommended during treatment and until B-cell recovery. Live vaccines should be administered at least 4 weeks prior to initiation of ublituximab-xiiy.(12) The US manufacturer of etrasimod states that live vaccines should be avoided during and for 5 weeks after treatment. Live vaccines should be administered at least 4 weeks prior to initiation of etrasimod.(13) The US manufacturer of emapalumab-lzsg states that live vaccines should not be administered to patients receiving emapalumab-lzsg and for at least 4 weeks after the last dose of emapalumab-lzsg. The safety of immunization with live vaccines during or following emapalumab-lzsg therapy has not been studied.(14) DISCUSSION: Killed or inactivated vaccines do not pose a danger to immunocompromised patients.(1) Patients with a history of leukemia who are in remission and have not received chemotherapy for at least 3 months are not considered to be immunocompromised.(1) |
ACAM2000 (NATIONAL STOCKPILE), ADENOVIRUS TYPE 4, ADENOVIRUS TYPE 4 AND TYPE 7, ADENOVIRUS TYPE 7, BCG (TICE STRAIN), BCG VACCINE (TICE STRAIN), DENGVAXIA, ERVEBO (NATIONAL STOCKPILE), FLUMIST 2025-2026, FLUMIST HOME 2025-2026, IXCHIQ, M-M-R II VACCINE, PRIORIX, PROQUAD, ROTARIX, ROTATEQ, STAMARIL, VARIVAX VACCINE, VAXCHORA ACTIVE COMPONENT, VAXCHORA VACCINE, VIVOTIF, YF-VAX |
| Talimogene laherparepvec/Selected Immunosuppressants SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Talimogene laherparepvec is a live, attenuated herpes simplex virus.(1) CLINICAL EFFECTS: Concurrent use of talimogene laherparepvec in patients receiving immunosuppressive therapy may cause a life-threatening disseminated herpetic infection.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Talimogene laherparepvec is contraindicated in immunosuppressed patients.(1) The magnitude of immunocompromise and associated risks due to immunosuppressant drugs should be determined by a physician. DISCUSSION: Concurrent use of talimogene laherparepvec in patients receiving immunosuppressive therapy may cause a life-threatening disseminated herpetic infection.(1) |
IMLYGIC |
| Nadofaragene Firadenovec/Selected Immunosuppressants SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Nadofaragene firadenovec may contain low levels of replication-competent adenovirus.(1) CLINICAL EFFECTS: Concurrent use of nadofaragene firadenovec in patients receiving immunosuppressive therapy may cause disseminated adenovirus infection.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Individuals who are immunosuppressed or immune-deficient should not receive nadofaragene firadenovec.(1) DISCUSSION: Nadofaragene firadenovec is a non-replicating adenoviral vector-based gene therapy but may contain low levels of replication-competent adenovirus. Immunocompromised persons, including those receiving immunosuppressant therapy, may be at risk for disseminated adenovirus infection.(1) |
ADSTILADRIN |
There are 19 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Carmustine/Cimetidine SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. Both carmustine and cimetidine have bone marrow suppression properties, which may be additive during concurrent therapy. It has also been suggested that cimetidine may inhibit the metabolism of carmustine.(1) CLINICAL EFFECTS: Cimetidine may enhance carmustine-induced bone marrow suppression, including leukopenia and neutropenia. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid concomitant use of these medications. If the drugs are used together, monitor for excessive bone marrow toxicity. Since other H-2 antagonists (e.g., ranitidine, famotidine) do not appear to interact, substituting cimetidine with one of these agents may be desirable. However, if a patient is already receiving this combination and is not experiencing adverse effects, substitution is probably not necessary. DISCUSSION: Additive bone marrow depression was seen in patients receiving concurrent therapy with carmustine and cimetidine when compared to control patients not receiving cimetidine.(2,3) In an animal study, rats were given a single injection of cimetidine at various times up to 30 minutes before or up to 60 minutes after a carmustine injection. Enhanced carmustine bone marrow toxicity was seen with concurrent administration of cimetidine.(4) |
CIMETIDINE |
| Deferiprone/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis may increase the frequency or risk for severe toxicity.(1) CLINICAL EFFECTS: Concurrent use of deferiprone and myelosuppressive agents may result in severe neutropenia or agranulocytosis, which may be fatal. PREDISPOSING FACTORS: Agranulocytosis may be less common in patients receiving deferiprone for thalassemia, and more common in patients treated for other systemic iron overload conditions (e.g. myelodysplastic syndromes, sickle cell disease).(2,3) Inadequate monitoring appears to increase the risk for severe outcomes. Manufacturer post market surveillance found that in all fatal cases of agranulocytosis reported between 1999 and 2005, data on weekly white blood count (WBC) monitoring was missing. In three fatal cases, deferiprone was continued for two to seven days after the detection of neutropenia or agranulocytosis.(2) PATIENT MANAGEMENT: If possible, discontinue one of the drugs associated with risk for neutropenia or agranulocytosis. If alternative therapy is not available, documentation and adherence to the deferiprone monitoring protocol is essential. Baseline absolute neutrophil count (ANC) must be at least 1,500/uL prior to starting deferiprone. Monitor ANC weekly during therapy. If infection develops, interrupt deferiprone therapy and monitor ANC more frequently. If ANC is less than 1,500/uL but greater than 500/uL, discontinue deferiprone and any other drugs possibly associated with neutropenia. Initiate ANC and platelet counts daily until recovery (i.e. ANC at least 1,500/uL). If ANC is less than 500/uL, discontinue deferiprone, evaluate patient and hospitalize if appropriate. Do not resume deferiprone unless potential benefits outweigh potential risks.(1) DISCUSSION: Drugs linked to this monograph have an FDA Boxed Warning for risk of neutropenia, agranulocytosis, or pancytopenia, or have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(1-25) In pooled clinical studies submitted to the FDA, 6.1% of deferiprone patients met criteria for neutropenia and 1.7% of patients developed agranulocytosis.(1) The time to onset of agranulocytosis was highly variable with a range of 65 days to 9.2 years (median, 161 days).(3) |
DEFERIPRONE, DEFERIPRONE (3 TIMES A DAY), FERRIPROX, FERRIPROX (2 TIMES A DAY), FERRIPROX (3 TIMES A DAY) |
| Tofacitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of tofacitinib and azathioprine, other biologic disease-modifying antirheumatic drugs (DMARDs), or potent immunosuppressants may result in additive or synergistic effects on the immune system.(1) CLINICAL EFFECTS: Concurrent use of tofacitinib and azathioprine, other biologic DMARDs, or potent immunosuppressants use may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Tofacitinib should not be used concurrently with azathioprine, other biologic DMARDs, or cyclosporine.(1) Patient should be monitored for decreases in lymphocytes and neutrophils. Therapy should be adjusted based on the indication. - For all indications: If absolute neutrophil count (ANC) or lymphocyte count is less than 500 cells/mm3, discontinue tofacitinib. - For rheumatoid arthritis or psoriatic arthritis and absolute neutrophil count (ANC) 500 to 1000 cells/mm3: interrupt dosing. When ANC is greater than 1000 cells/mm3, resume Xeljanz 5 mg twice daily or Xeljanz XR 11 mg once daily. - For ulcerative colitis and ANC 500 to 1000 cells/mm3: -If taking Xeljanz 10 mg twice daily, decrease to 5 mg twice daily. When ANC is greater than 1000 cells/mm3, increase to 10 mg twice daily based on clinical response. -If taking Xeljanz 5 mg twice daily, interrupt dosing. When ANC is greater than 1000 cells/mm3, resume 5 mg twice daily. -If taking Xeljanz XR 22 mg once daily, decrease to 11 mg once daily. When ANC is greater than 1000 cells/mm3, increase to 22 mg once daily based on clinical response. -If taking Xeljanz XR 11 mg once daily, interrupt dosing. When ANC is greater than 1000 cells/mm3, resume 11 mg once daily. - For polyarticular course juvenile idiopathic arthritis (pcJIA) and ANC 500 to 1000 cells/mm3: interrupt dosing until ANC is greater than 1000 cells/mm3.(1) DISCUSSION: Concurrent use of tofacitinib and azathioprine, other biologic DMARDs, or potent immunosuppressants may increase the risk of infection.(1) |
TOFACITINIB CITRATE, XELJANZ, XELJANZ XR |
| Clozapine/Selected Myelosuppressive Agents SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Clozapine and other myelosuppressive agents may be associated with neutropenia or agranulocytosis.(2) CLINICAL EFFECTS: Moderate neutropenia, even if due to combination therapy, may require abrupt discontinuation of clozapine resulting in decompensation of the patient's psychiatric disorder (e.g. schizophrenia). The disease treated by the myelosuppressive agent may be compromised if myelosuppression requires dose reduction, delay, or discontinuation of the myelosuppressive agent. Undetected severe neutropenia or agranulocytosis may be fatal. PREDISPOSING FACTORS: Low white blood counts prior to initiation of the myelosuppressive agent may increase risk for clinically significant neutropenia. PATIENT MANAGEMENT: If a patient stabilized on clozapine therapy requires treatment with a myelosuppressive agent, the clozapine prescriber should consult with prescriber of the myelosuppressive agent (e.g. oncologist) to discuss treatment and monitoring options.(2) More frequent ANC monitoring or treatment alternatives secondary to neutropenic episodes may need to be considered. Clozapine is only available through a restricted distribution system which requires documentation of the absolute neutrophil count (ANC) prior to dispensing.(1-2) For most clozapine patients, clozapine treatment must be interrupted for a suspected clozapine-induced ANC < 1000 cells/microliter. For patients with benign ethnic neutropenia (BEN), treatment must be interrupted for suspected clozapine-induced neutropenia < 500 cells/microliter.(2) DISCUSSION: Clozapine is only available through a restricted distribution system which requires documentation of the ANC prior to dispensing.(1) Agents linked to this interaction generally have > 5% risk for neutropenia and/or warnings describing risk for myelosuppression in manufacturer prescribing information.(3-26) |
CLOZAPINE, CLOZAPINE ODT, CLOZARIL, VERSACLOZ |
| Selected Multiple Sclerosis Agents/Immunosuppressants; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ocrelizumab or ofatumumab in combination with immunosuppressives and immune-modulators all suppress the immune system.(1,2) CLINICAL EFFECTS: Concurrent use of ocrelizumab or ofatumumab with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1,2) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ocrelizumab US prescribing information states: - Ocrelizumab and other immune-modulating or immunosuppressive therapies, (including immunosuppressant doses of corticosteroids) are expected to increase the risk of immunosuppression, and the risk of additive immune system effects must be considered if these therapies are coadministered with ocrelizumab. When switching from drugs with prolonged immune effects, such as daclizumab, fingolimod, natalizumab, teriflunomide, or mitoxantrone, the duration and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects when initiating ocrelizumab.(1) The ofatumumab US prescribing information states: - Ofatumumab and other immunosuppressive therapies (including systemic corticosteroids) may have the potential for increased immunosuppressive effects and increase the risk of infection. When switching between therapies, the duration and mechanism of action of each therapy should be considered due to the potential for additive immunosuppressive effects. Ofatumumab for MS therapy has not been studied in combination with other MS agents that suppress the immune system.(2) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1,2) In a retrospective cohort study of multiple sclerosis patients newly initiated on a disease-modifying therapy, use of high-efficacy agents (alemtuzumab, natalizumab, or ocrelizumab) resulted in the same risk of overall infections as moderate-efficacy agents, but there was an elevated risk of serious infections (adjusted hazard ratio [aHR] = 1.24, 95% confidence interval (CI) = 1.06-1.44) and UTIs (aHR = 1.21, 95% CI = 1.14-1.30).(3) |
KESIMPTA PEN, OCREVUS, OCREVUS ZUNOVO |
| Upadacitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Upadacitinib, immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of upadacitinib with immunosuppressives or immunomodulators may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of upadacitinib states that concurrent use of upadacitinib with immunosuppressives or immunomodulators is not recommended. DISCUSSION: Serious infections have been reported in patients receiving upadacitinib. Reported infections included pneumonia, cellulitis, tuberculosis, multidermatomal herpes zoster, oral/esophageal candidiasis, cryptococcosis. Reports of viral reactivation, including herpes virus reactivation and hepatitis B reactivation, were reported in clinical studies with upadacitinib.(1) |
RINVOQ, RINVOQ LQ |
| Inebilizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Inebilizumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of inebilizumab with immunosuppressive or immunomodulating agents may result in myelosuppression including neutropenia resulting in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of inebilizumab states that the concurrent use of inebilizumab with immunosuppressive agents, including systemic corticosteroids, may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Inebilizumab has not been studied in combination with other immunosuppressants. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents. The most common infections reported by inebilizumab treated patients in the randomized and open-label clinical trial periods included urinary tract infections (20%), nasopharyngitis (13%), upper respiratory tract infections (8%), and influenza (7%). Although there been no cases of Hepatitis B virus reactivation or progressive multifocal leukoencephalopathy reported in patients taking inebilizumab, these infections have been observed in patients taking other B-cell-depleting antibodies.(1) |
UPLIZNA |
| Baricitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of baricitinib with other biologic disease-modifying antirheumatic drugs (DMARDs) or potent immunosuppressants such as azathioprine or cyclosporine may result in additive or synergistic effects on the immune system. CLINICAL EFFECTS: Concurrent use of baricitinib with other biologic DMARDs or potent immunosuppressants such as azathioprine or cyclosporine may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of baricitinib states that concurrent use of baricitinib with biologic DMARDs or potent immunosuppressants is not recommended.(1) DISCUSSION: Most patients who developed serious infections while being treated with baricitinib were on concomitant immunosuppressants like methotrexate and corticosteroids. The combination of baricitinib with other biologic DMARDs has not been studied.(1) |
OLUMIANT |
| Leflunomide; Teriflunomide/Selected Immunosuppressants SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of leflunomide or teriflunomide and potent immunosuppressants may result in additive or synergistic effects on the immune system.(1,2) Leflunomide is a prodrug and is converted to its active metabolite teriflunomide.(1) CLINICAL EFFECTS: Concurrent use of leflunomide or teriflunomide with immunosuppressants may result in an increased risk of serious infections, including opportunistic infections, especially Pneumocystis jiroveci pneumonia, tuberculosis (including extra-pulmonary tuberculosis), and aspergillosis. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: If leflunomide or teriflunomide is used concurrently with immunosuppressive agents, chronic CBC monitoring should be performed more frequently, every month instead of every 6 to 8 weeks. If bone marrow suppression or a serious infection occurs, leflunomide or teriflunomide should be stopped and rapid drug elimination procedure should be performed.(1,2) DISCUSSION: Pancytopenia, agranulocytosis and thrombocytopenia have been reported in patients receiving leflunomide or teriflunomide alone, but most frequently in patients taking concurrent immunosuppressants.(1,2) Severe and potentially fatal infections, including sepsis, have been reported in patients receiving leflunomide or teriflunomide, especially Pneumocystis jiroveci pneumonia and aspergillosis. Tuberculosis has also been reported.(1,2) |
ARAVA, AUBAGIO, LEFLUNICLO, LEFLUNOMIDE, TERIFLUNOMIDE |
| Ponesimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ponesimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ponesimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ponesimod US prescribing information states ponesimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the weeks following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ponesimod after alemtuzumab is not recommended. However, ponesimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
PONVORY |
| Sodium Iodide I 131/Myelosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Sodium iodide I 131 can cause depression of the hematopoetic system. Myelosuppressives and immunomodulators also suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of sodium iodide I 131 with agents that cause bone marrow depression, including myelosuppressives or immunomodulators, may result in an enhanced risk of hematologic disorders, including anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia. Bone marrow depression may increase the risk of serious infections and bleeding.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of sodium iodide I 131 states that concurrent use with bone marrow depressants may enhance the depression of the hematopoetic system caused by large doses of sodium iodide I 131.(1) Sodium iodide I 131 causes a dose-dependent bone marrow suppression, including neutropenia or thrombocytopenia, in the 3 to 5 weeks following administration. Patients may be at increased risk of infections or bleeding during this time. Monitor complete blood counts within one month of therapy. If results indicate leukopenia or thrombocytopenia, dosimetry should be used to determine a safe sodium iodide I 131 activity.(1) DISCUSSION: Hematologic disorders including death have been reported with sodium iodide I 131. The most common hematologic disorders reported include anemia, blood dyscrasias, bone marrow depression, leukopenia, and thrombocytopenia.(1) |
HICON, SODIUM IODIDE I-131 |
| Fingolimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fingolimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-3) CLINICAL EFFECTS: Concurrent use of fingolimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1-3) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for fingolimod regarding this interaction differ between regulatory approving agencies. The fingolimod US prescribing information states: - Antineoplastic, immune-modulating, or immunosuppressive therapies, (including corticosteroids) are expected to increase the risk of immunosuppression, and the risk of additive immune system effects must be considered if these therapies are coadministered with fingolimod. When switching from drugs with prolonged immune effects, such as natalizumab, teriflunomide or mitoxantrone, the duration and mode of action of these drugs must be considered to avoid unintended additive immunosuppressive effects when initiating fingolimod.(1) The fingolimod Canadian prescribing information states: - Concurrent use with immunosuppressive or immunomodulatory agents is contraindicated due to the risk of additive immune system effects. However, co-administration of a short course of corticosteroids (up to 5 days) did not increase the overall rate of infection in patients participating Phase III clinical trials.(2) The fingolimod UK specific product characteristics states: - Fingolimod is contraindicated in patients currently receiving immunosuppressive therapies or those immunocompromised by prior therapies. When switching patients from another disease modifying therapy to Gilenya, the half-life and mode of action of the other therapy must be considered in order to avoid an additive immune effect whilst at the same time minimizing the risk of disease activation.(3) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1-3) |
FINGOLIMOD, GILENYA, TASCENSO ODT |
| Ozanimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ozanimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ozanimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The ozanimod US prescribing information state this information regarding this interaction: -Ozanimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with ozanimod after alemtuzumab is not recommended. However, ozanimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
ZEPOSIA |
| Siponimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Siponimod in combination with immunosuppressives and immune-modulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of siponimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The siponimod US prescribing information state this information regarding this interaction: -Siponimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Caution should be used during concomitant administration because of the risk of additive immune effects during therapy and in the week following administration. When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects. Initiating treatment with siponimod after alemtuzumab is not recommended. However, siponimod can generally be started immediately after discontinuation of beta interferon or glatiramer acetate.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1) |
MAYZENT |
| Cladribine/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Cladribine in combination with immunosuppressives and immune-modulators all suppress the immune system.(1-2) CLINICAL EFFECTS: Concurrent use of cladribine with immunosuppressive or immune-modulating agents may result in an increased risk of serious infections, such as disseminated herpetic infection or progressive multifocal leukoencephalopathy (PML), an opportunistic infection caused by the JC virus (JCV).(1-2) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: Recommendations for cladribine regarding this interaction differ between regulatory approving agencies. The cladribine US prescribing information states: -Concomitant use with myelosuppressive or other immunosuppressive drugs is not recommended. Acute short-term therapy with corticosteroids can be administered. In patients who have previously been treated with immunomodulatory or immunosuppressive drugs, consider potential additive effect, the mode of action, and duration of effect of the other drugs prior to initiation of cladribine.(1) The cladribine Canadian prescribing information states: -Use of cladribine in immunocompromised patients is contraindicated because of a risk of additive effects on the immune system. Acute short-term therapy with corticosteroids can be administered during cladribine treatment.(2) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients who previously received immunomodulators or immunosuppressants.(1-2) |
CLADRIBINE, MAVENCLAD |
| Ritlecitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ritlecitinib, immunosuppressives, and immunomodulators all suppress the immune system. CLINICAL EFFECTS: Concurrent use of ritlecitinib with immunosuppressives or immunomodulators may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of ritlecitinib states that concurrent use of ritlecitinib with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants is not recommended.(1) DISCUSSION: Serious infections have been reported in patients receiving ritlecitinib. Reported infections included appendicitis, COVID-19 infection (including pneumonia), and sepsis. Reports of viral reactivation, including herpes virus reactivation was reported in clinical studies with ritlecitinib.(1) |
LITFULO |
| Etrasimod/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Etrasimod causes reversible sequestration of lymphocytes in lymphoid tissues, resulting in a mean 55% decrease in peripheral blood lymphocyte count at 52 weeks.(1) Other immunosuppressives and immune-modulators also suppress the immune system. CLINICAL EFFECTS: Concurrent use of etrasimod with immunosuppressive or immune-modulating agents may result in an increased risk of serious and fatal infections, such as disseminated herpetic infection, cryptococcal infection, or progressive multifocal leukoencephalopathy (PML).(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications increases the risk of adverse effects. PATIENT MANAGEMENT: The etrasimod US prescribing information states etrasimod has not been studied in combination with anti-neoplastic, immune-modulating, or immunosuppressive therapies. Concomitant administration of these therapies with etrasimod should be avoided because of the risk of additive immune effects during therapy and in the weeks following administration. Etrasimod's effect on peripheral lymphocytes may persist for up to 5 weeks after discontinuation.(1) When switching from drugs with prolonged immune effects, the half-life and mode of action of these drugs must be considered in order to avoid unintended additive immunosuppressive effects.(1) DISCUSSION: Fatal disseminated herpes zoster and herpes simplex infections, cryptococcal meningitis, disseminated cryptococcal infections, and cases of progressive multifocal leukoencephalopathy (PML) have been reported in patients treated with other sphingosine-1 phosphate receptor modulators.(1) |
VELSIPITY |
| Ropeginterferon alfa-2b/Slt Immunosuppress; Immunomodulator SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Ropeginterferon alfa-2b and immunosuppressives both suppress the immune system. CLINICAL EFFECTS: Concurrent use of ropeginterferon alfa-2b with immunosuppressives may result in an increased risk of serious infections. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Avoid concurrent use of myelosuppressive agents.(1-2) If concurrent use cannot be avoided, monitor for effects of excessive immunosuppression. DISCUSSION: In clinical trials, 20% of patients experienced leukopenia. Interferon alfa products may cause fatal or life-threatening infections.(1-2) |
BESREMI |
| Deuruxolitinib/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Deuruxolitinib, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of deuruxolitinib and potent immunosuppressants may increase the risk of serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of deuruxolitinib states that concurrent use of deuruxolitinib with other JAK inhibitors, biologic immunomodulators, cyclosporine or other potent immunosuppressants is not recommended.(1) If concurrent use cannot be avoided, patients should be monitored for signs and symptoms of infection. If a patient develops a serious or opportunistic infection, interrupt deuruxolitinib treatment until the infection is controlled. DISCUSSION: Serious infections have been reported in patients receiving treatment with deuruxolitinib.(1) |
LEQSELVI |
There are 7 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Hydantoins/Selected Antineoplastics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Antineoplastic agents may decrease the absorption and increase the metabolism of phenytoin. CLINICAL EFFECTS: The pharmacological effects of phenytoin may be decreased. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor serum phenytoin concentrations when starting or discontinuing cancer chemotherapy. Adjust the dose of phenytoin as needed. DISCUSSION: Decreased plasma phenytoin concentrations and loss of seizure control have been reported after starting chemotherapy in patients receiving phenytoin. In order to maintain adequate levels of phenytoin during chemotherapy, it may be necessary to increase the dose of phenytoin. |
CEREBYX, DILANTIN, DILANTIN-125, FOSPHENYTOIN SODIUM, PHENYTEK, PHENYTOIN, PHENYTOIN SODIUM, PHENYTOIN SODIUM EXTENDED |
| Digoxin, Oral/Antineoplastics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Decreased gastrointestinal digoxin absorption. CLINICAL EFFECTS: The pharmacologic effects of digoxin may be decreased. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor serum digoxin concentrations and observe the patient for a decrease in pharmacologic activity. Adjust the dose of digoxin accordingly. Substituting digitoxin or digoxin capsules for digoxin tablets may circumvent this interaction. DISCUSSION: There are a number of factors affecting the outcome of this interaction. The effects of antineoplastic therapy on the gastrointestinal absorption of digoxin have only been studied with certain chemotherapeutic agents or regimens (e.g., bleomycin, carmustine, cyclophosphamide, cytarabine, doxorubicin, methotrexate, procarbazine, vincristine). The interaction appears to occur with the administration of oral digoxin tablets as opposed to digoxin capsules. The gastrointestinal absorption of digitoxin does not seem to be altered by antineoplastic therapy. |
DIGITEK, DIGOXIN, LANOXIN |
| Ustekinumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Ustekinumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ustekinumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of ustekinumab recommends caution because the concurrent use of ustekinumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Ustekinumab has not been studied in combination with other immunosuppressants in psoriasis studies. In psoriatic arthritis studies, concomitant methotrexate use did not appear to influence the safety or efficacy of ustekinumab. In Crohn's disease and ulcerative colitis studies, concomitant use of immunosuppressants or corticosteroids did not appear to influence the safety or efficacy of ustekinumab. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by ustekinumab treated patients in the clinical trial periods included nasopharyngitis(8%) and upper respiratory tract infection(5%). Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving ustekinumab. Cases of interstitial pneumonia, eosinophilic pneumonia, and cryptogenic organizing pneumonia resulting in respiratory failure or prolonged hospitalization have been reported in patients receiving ustekinumab.(1) |
IMULDOSA, OTULFI, PYZCHIVA, SELARSDI, STELARA, STEQEYMA, USTEKINUMAB, USTEKINUMAB-AEKN, USTEKINUMAB-TTWE, WEZLANA, YESINTEK |
| COVID-19 Vaccines/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Immunosuppressants and immunomodulators may prevent the immune system from properly responding to the COVID-19 vaccine.(1,2) CLINICAL EFFECTS: Administration of a COVID-19 vaccine with immunosuppressants or immunomodulators may interfere with vaccine-induced immune response and impair the efficacy of the vaccine. However, patients should be offered and given a COVID-19 vaccine even if the use and timing of immunosuppressive agents cannot be adjusted.(1,2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: In an effort to optimize COVID-19 vaccine response, the American College of Rheumatology (ACR) published conditional recommendations for administration of COVID-19 vaccines with immunosuppressants and immunomodulators.(1) The CDC also provides clinical considerations for COVID-19 vaccination in patients on immunosuppressants.(2) The CDC states that all immunocompromised patients over 6 months of age should receive at least 1 dose of COVID-19 vaccine if eligible. See the CDC's Interim Clinical Considerations for Use of COVID-19 Vaccines for specific recommendations based on age, vaccination history, and vaccine manufacturer.(2) The ACR states that in general, immunosuppressants and immunomodulators should be held for 1-2 weeks after each vaccine dose. See below for specific recommendations for certain agents.(1) The CDC advises planning for vaccination at least 2 weeks before starting or resuming immunosuppressive therapy.(2) Patients should be offered and given a COVID-19 vaccine even if the use and timing of immunosuppressive agents cannot be adjusted.(1,2) B-cell depleting agents, including rituximab: The ACR recommends consulting with the rheumatologist to determine optimal timing of COVID-19 vaccination. Measuring CD19 B cells may be considered to determine need for a booster vaccine dose. If B cell levels are not measured, a supplemental vaccine dose 2-4 weeks before the next scheduled dose of rituximab is recommended.(1) The CDC states that the utility of B-cell quantification to guide clinical care is not known and is not recommended. Patients who receive B-cell depleting therapy should receive COVID-19 vaccines about 4 weeks before the next scheduled dose. For patients who received 1 or more doses of COVID-19 vaccine during treatment with B-cell-depleting therapies that were administered over a limited period (e.g., as part of a treatment regimen for certain malignancies), revaccination may be considered. The suggested interval to start revaccination is about 6 months after completion of the B-cell-depleting therapy.(2) Abatacept: - Subcutaneous abatacept should be withheld for 1-2 weeks after each vaccine dose, as disease activity allows. - For intravenous abatacept, time administration so that vaccination will occur 1 week before the next abatacept infusion.(1) Cyclophosphamide: When feasible, administer cyclophosphamide one week after each COVID-19 vaccine dose.(1) Recipients of hematopoietic cell transplant or CAR-T-cell therapy who received one or more doses of COVID-19 vaccine prior to or during treatment should undergo revaccination following the current CDC recommendations for unvaccinated patients. Revaccination should start at least 3 months (12 weeks) after transplant or CAR-T-cell therapy.(2) TNF-alpha inhibitors and cytokine inhibitors: The ACR was not able to reach consensus on whether to modify dosing or timing of these agents with COVID-19 vaccination.(1) The CDC includes these agents in their general recommendation to hold therapy for at least 2 weeks following vaccination.(2) DISCUSSION: The ACR convened a COVID-19 Vaccine Guidance Task Force to provide guidance on optimal use of COVID-19 vaccines in rheumatology patients. These recommendations are based on limited clinical evidence of COVID-19 vaccines in patients without rheumatic and musculoskeletal disorders and evidence of other vaccines in this patient population.(1) The ACR recommendation for rituximab is based on studies of humoral immunity following receipt of other vaccines. These studies have uncertain generalizability to vaccination against COVID-19, as it is unknown if efficacy is attributable to induction of host T cells versus B cell (antibody-based) immunity.(1) The ACR recommendation for mycophenolate is based on preexisting data of mycophenolate on non-COVID-19 vaccine immunogenicity. Emerging data suggests that mycophenolate may impair SARS-CoV-2 vaccine response in rheumatic and musculoskeletal disease and transplant patients.(1) The ACR recommendation for methotrexate is based on data from influenza vaccines and pneumococcal vaccines with methotrexate.(1) The ACR recommendation for JAK inhibitors is based on concerns related to the effects of JAK inhibitors on interferon signaling that may result in a diminished vaccine response.(1) The ACR recommendation for subcutaneous abatacept is based on several studies suggesting a negative effect of abatacept on vaccine immunogenicity. The first vaccine dose primes naive T cells, naive T cell priming is inhibited by CTLA-4, and abatacept is a CTLA-4Ig construct. CTLA-4 should not inhibit boosts of already primed T cells at the time of the second vaccine dose.(1) |
COMIRNATY 2024-2025, MODERNA COVID 24-25(6M-11Y)EUA, NOVAVAX COVID 2024-2025 (EUA), PFIZER COVID 2024-25(5-11Y)EUA, PFIZER COVID 2024-25(6M-4Y)EUA, SPIKEVAX 2024-2025 |
| Sarilumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Sarilumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of sarilumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of sarilumab recommends caution because the concurrent use of sarilumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Sarilumab was studied as monotherapy and in combination with methotrexate or conventional disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis studies. Sarilumab has not been studied with biological DMARDs and concurrent use should be avoided. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by sarilumab treated patients in the clinical trial periods included pneumonia and cellulitis. Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving sarilumab. Cases of tuberculosis, candidiasis, and pneumocystis with sarilumab have been reported.(1) |
KEVZARA |
| Ublituximab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Ublituximab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of ublituximab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: Incomplete washout of previously prescribed immunosuppressive or immune-modulating medications. PATIENT MANAGEMENT: The US manufacturer of ublituximab recommends caution because the concurrent use of ublituximab with immunomodulating or immunosuppressive agents, including immunosuppressant doses of corticosteroids, may increase the risk of infection.(1) If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents. When switching from agents with immune effects, the half-life and mechanism of action of these drugs must be taken into consideration in order to prevent additive immunosuppressive effects.(1) DISCUSSION: The most common infections reported by ublituximab-treated patients in the clinical trial periods included upper respiratory tract infections and urinary tract infections. Serious, including life-threatening or fatal, bacterial and viral infections were observed in patients receiving ublituximab.(1) Serious and/or fatal bacterial, fungal, and new or reactivated viral infections have been associated with other anti-CD20 B-cell depleting therapies. There were no cases of progressive multifocal leukoencephalopathy (PML) reported during the clinical trials; however, there have been reports of PML during or following completion of other anti-CD20 B-cell depleting therapies.(1) |
BRIUMVI |
| Tocilizumab/Immunosuppressives; Immunomodulators SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Tocilizumab, immunosuppressives, and immunomodulators all suppress the immune system.(1) CLINICAL EFFECTS: Concurrent use of tocilizumab with immunosuppressive or immunomodulating agents may result in an increased risk for serious infections.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of tocilizumab recommends caution because the concurrent use of tocilizumab with immunosuppressive agents may increase the risk of infection. If concurrent therapy is warranted, consider the risk of additive immune suppression and monitor based on prescribing information for both agents.(1) DISCUSSION: Tocilizumab was studied as monotherapy and in combination with methotrexate, non-biologic DMARDs or corticosteroids, depending on the indication. Tocilizumab has not been studied with biological DMARDs and concurrent use should be avoided. If concurrent therapy is warranted, consider the potential for increased immunosuppressive risks from both agents.(1) The most common infections reported by tocilizumab treated patients in the clinical trial periods included pneumonia, urinary tract infection, cellulitis, herpes zoster, gastroenteritis, diverticulitis, sepsis and bacterial arthritis. Serious bacterial, mycobacterial, fungal, and viral infections were observed in patients receiving tocilizumab. Cases of tuberculosis, cryptococcus, aspergillosis, candidiasis, and pneumocystosis have been reported.(1) |
ACTEMRA, ACTEMRA ACTPEN, TOFIDENCE, TYENNE, TYENNE AUTOINJECTOR |
The following contraindication information is available for CARMUSTINE (carmustine):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 2 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Hemorrhage |
| Lactation |
There are 8 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Disease of liver |
| Leukopenia |
| Neutropenic disorder |
| Pregnancy |
| Pulmonary fibrosis |
| Pulmonary infiltrates |
| Severe infection |
| Thrombocytopenic disorder |
There are 3 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Acute leukemia |
| Anemia |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
The following adverse reaction information is available for CARMUSTINE (carmustine):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 25 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Infection Interstitial pneumonitis Kidney disease with reduction in glomerular filtration rate (GFr) Leukopenia Pulmonary fibrosis Thrombocytopenic disorder |
Anemia Flushing Neutropenic disorder Pulmonary infiltrates |
| Rare/Very Rare |
|---|
|
Abnormal hepatic function tests Acute leukemia Allergic reaction Azotemia Chest pain Conjunctival hemorrhage Dermal necrosis Drug-induced hepatitis Encephalopathy Extravasation injury Hepatic veno-occlusive disease Hyperbilirubinemia Neuroretinitis Renal failure Seizure disorder |
There are 12 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Nausea Vomiting |
Injection site sequelae |
| Rare/Very Rare |
|---|
|
Alopecia Blurred vision Chemosis Diarrhea Gynecomastia Headache disorder Hypotension Skin pigmentation enhancement Tachycardia |
The following precautions are available for CARMUSTINE (carmustine):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Carmustine may cause fetal harm when administered to pregnant women, but potential benefits from use of the drug may be acceptable in certain conditions despite possible risks to the fetus. Carmustine has been shown to be teratogenic in rats and embryotoxic in rats and rabbits receiving dosages approximating the usual human dosage. There are no adequate and controlled studies to date using carmustine or carmustine wafer implants in pregnant women, and the drug should be used during pregnancy only in life-threatening situations or severe disease for which safer drugs cannot be used or are ineffective.
Women of childbearing potential should be advised to avoid becoming pregnant during carmustine therapy. When the drug is administered during pregnancy or if the patient becomes pregnant while receiving the drug, the patient should be informed of the potential hazard to the fetus.
Women of childbearing potential should be advised to avoid becoming pregnant during carmustine therapy. When the drug is administered during pregnancy or if the patient becomes pregnant while receiving the drug, the patient should be informed of the potential hazard to the fetus.
It is not known whether carmustine is distributed in milk. Because of the potential for serious adverse reactions to carmustine in nursing infants, nursing should be discontinued during systemic carmustine therapy. It is not known whether components of the carmustine wafer, including carmustine, carboxyphenoxypropane, or sebacic acid, are distributed in milk. Because of the potential for serious adverse reactions to carmustine in nursing infants, nursing should be discontinued in patients receiving carmustine wafer implants.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for CARMUSTINE (carmustine):
WARNING: Carmustine may cause serious bleeding/blood problems. This effect can cause anemia, lower your body's ability to fight an infection, or cause your body to bruise or bleed more easily. Your doctor will check you closely during and for at least 6 weeks after treatment to lessen the chance of serious side effects.
Tell your doctor right away if you develop symptoms such as easy bruising/bleeding, unusual tiredness, signs of infection (such as sore throat that doesn't go away, fever, chills). This medication may also cause very serious (possibly fatal) lung problems. The risk increases after receiving higher total doses and can occur years after treatment. Tell your doctor right away if you develop symptoms such as cough that doesn't go away, shortness of breath, chest pain, unusual weakness/tiredness.
WARNING: Carmustine may cause serious bleeding/blood problems. This effect can cause anemia, lower your body's ability to fight an infection, or cause your body to bruise or bleed more easily. Your doctor will check you closely during and for at least 6 weeks after treatment to lessen the chance of serious side effects.
Tell your doctor right away if you develop symptoms such as easy bruising/bleeding, unusual tiredness, signs of infection (such as sore throat that doesn't go away, fever, chills). This medication may also cause very serious (possibly fatal) lung problems. The risk increases after receiving higher total doses and can occur years after treatment. Tell your doctor right away if you develop symptoms such as cough that doesn't go away, shortness of breath, chest pain, unusual weakness/tiredness.
The following icd codes are available for CARMUSTINE (carmustine)'s list of indications:
| Anaplastic astrocytoma | |
| C71 | Malignant neoplasm of brain |
| C71.0 | Malignant neoplasm of cerebrum, except lobes and ventricles |
| C71.1 | Malignant neoplasm of frontal lobe |
| C71.2 | Malignant neoplasm of temporal lobe |
| C71.3 | Malignant neoplasm of parietal lobe |
| C71.4 | Malignant neoplasm of occipital lobe |
| C71.5 | Malignant neoplasm of cerebral ventricle |
| C71.6 | Malignant neoplasm of cerebellum |
| C71.7 | Malignant neoplasm of brain stem |
| C71.8 | Malignant neoplasm of overlapping sites of brain |
| C71.9 | Malignant neoplasm of brain, unspecified |
| Glioblastoma multiforme | |
| C71 | Malignant neoplasm of brain |
| C71.0 | Malignant neoplasm of cerebrum, except lobes and ventricles |
| C71.1 | Malignant neoplasm of frontal lobe |
| C71.2 | Malignant neoplasm of temporal lobe |
| C71.3 | Malignant neoplasm of parietal lobe |
| C71.4 | Malignant neoplasm of occipital lobe |
| C71.5 | Malignant neoplasm of cerebral ventricle |
| C71.6 | Malignant neoplasm of cerebellum |
| C71.7 | Malignant neoplasm of brain stem |
| C71.8 | Malignant neoplasm of overlapping sites of brain |
| C71.9 | Malignant neoplasm of brain, unspecified |
| Hodgkin's lymphoma | |
| C81 | Hodgkin lymphoma |
| C81.0 | Nodular lymphocyte predominant hodgkin lymphoma |
| C81.00 | Nodular lymphocyte predominant hodgkin lymphoma, unspecified site |
| C81.01 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.02 | Nodular lymphocyte predominant hodgkin lymphoma, intrathoracic lymph nodes |
| C81.03 | Nodular lymphocyte predominant hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.04 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.05 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.06 | Nodular lymphocyte predominant hodgkin lymphoma, intrapelvic lymph nodes |
| C81.07 | Nodular lymphocyte predominant hodgkin lymphoma, spleen |
| C81.08 | Nodular lymphocyte predominant hodgkin lymphoma, lymph nodes of multiple sites |
| C81.09 | Nodular lymphocyte predominant hodgkin lymphoma, extranodal and solid organ sites |
| C81.1 | Nodular sclerosis hodgkin lymphoma |
| C81.10 | Nodular sclerosis hodgkin lymphoma, unspecified site |
| C81.11 | Nodular sclerosis hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.12 | Nodular sclerosis hodgkin lymphoma, intrathoracic lymph nodes |
| C81.13 | Nodular sclerosis hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.14 | Nodular sclerosis hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.15 | Nodular sclerosis hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.16 | Nodular sclerosis hodgkin lymphoma, intrapelvic lymph nodes |
| C81.17 | Nodular sclerosis hodgkin lymphoma, spleen |
| C81.18 | Nodular sclerosis hodgkin lymphoma, lymph nodes of multiple sites |
| C81.19 | Nodular sclerosis hodgkin lymphoma, extranodal and solid organ sites |
| C81.2 | Mixed cellularity hodgkin lymphoma |
| C81.20 | Mixed cellularity hodgkin lymphoma, unspecified site |
| C81.21 | Mixed cellularity hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.22 | Mixed cellularity hodgkin lymphoma, intrathoracic lymph nodes |
| C81.23 | Mixed cellularity hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.24 | Mixed cellularity hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.25 | Mixed cellularity hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.26 | Mixed cellularity hodgkin lymphoma, intrapelvic lymph nodes |
| C81.27 | Mixed cellularity hodgkin lymphoma, spleen |
| C81.28 | Mixed cellularity hodgkin lymphoma, lymph nodes of multiple sites |
| C81.29 | Mixed cellularity hodgkin lymphoma, extranodal and solid organ sites |
| C81.3 | Lymphocyte depleted hodgkin lymphoma |
| C81.30 | Lymphocyte depleted hodgkin lymphoma, unspecified site |
| C81.31 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.32 | Lymphocyte depleted hodgkin lymphoma, intrathoracic lymph nodes |
| C81.33 | Lymphocyte depleted hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.34 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.35 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.36 | Lymphocyte depleted hodgkin lymphoma, intrapelvic lymph nodes |
| C81.37 | Lymphocyte depleted hodgkin lymphoma, spleen |
| C81.38 | Lymphocyte depleted hodgkin lymphoma, lymph nodes of multiple sites |
| C81.39 | Lymphocyte depleted hodgkin lymphoma, extranodal and solid organ sites |
| C81.4 | Lymphocyte-rich hodgkin lymphoma |
| C81.40 | Lymphocyte-rich hodgkin lymphoma, unspecified site |
| C81.41 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.42 | Lymphocyte-rich hodgkin lymphoma, intrathoracic lymph nodes |
| C81.43 | Lymphocyte-rich hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.44 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.45 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.46 | Lymphocyte-rich hodgkin lymphoma, intrapelvic lymph nodes |
| C81.47 | Lymphocyte-rich hodgkin lymphoma, spleen |
| C81.48 | Lymphocyte-rich hodgkin lymphoma, lymph nodes of multiple sites |
| C81.49 | Lymphocyte-rich hodgkin lymphoma, extranodal and solid organ sites |
| C81.7 | Other hodgkin lymphoma |
| C81.70 | Other hodgkin lymphoma, unspecified site |
| C81.71 | Other hodgkin lymphoma, lymph nodes of head, face, and neck |
| C81.72 | Other hodgkin lymphoma, intrathoracic lymph nodes |
| C81.73 | Other hodgkin lymphoma, intra-abdominal lymph nodes |
| C81.74 | Other hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C81.75 | Other hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C81.76 | Other hodgkin lymphoma, intrapelvic lymph nodes |
| C81.77 | Other hodgkin lymphoma, spleen |
| C81.78 | Other hodgkin lymphoma, lymph nodes of multiple sites |
| C81.79 | Other hodgkin lymphoma, extranodal and solid organ sites |
| C81.9 | Hodgkin lymphoma, unspecified |
| C81.90 | Hodgkin lymphoma, unspecified, unspecified site |
| C81.91 | Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck |
| C81.92 | Hodgkin lymphoma, unspecified, intrathoracic lymph nodes |
| C81.93 | Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes |
| C81.94 | Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C81.95 | Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C81.96 | Hodgkin lymphoma, unspecified, intrapelvic lymph nodes |
| C81.97 | Hodgkin lymphoma, unspecified, spleen |
| C81.98 | Hodgkin lymphoma, unspecified, lymph nodes of multiple sites |
| C81.99 | Hodgkin lymphoma, unspecified, extranodal and solid organ sites |
| Malignant brain neoplasm | |
| C71 | Malignant neoplasm of brain |
| C71.0 | Malignant neoplasm of cerebrum, except lobes and ventricles |
| C71.1 | Malignant neoplasm of frontal lobe |
| C71.2 | Malignant neoplasm of temporal lobe |
| C71.3 | Malignant neoplasm of parietal lobe |
| C71.4 | Malignant neoplasm of occipital lobe |
| C71.5 | Malignant neoplasm of cerebral ventricle |
| C71.6 | Malignant neoplasm of cerebellum |
| C71.7 | Malignant neoplasm of brain stem |
| C71.8 | Malignant neoplasm of overlapping sites of brain |
| C71.9 | Malignant neoplasm of brain, unspecified |
| Malignant glioma | |
| C71.9 | Malignant neoplasm of brain, unspecified |
| D43.2 | Neoplasm of uncertain behavior of brain, unspecified |
| Multiple myeloma | |
| C90.0 | Multiple myeloma |
| C90.00 | Multiple myeloma not having achieved remission |
| C90.02 | Multiple myeloma in relapse |
| Non-hodgkin's lymphoma | |
| C82 | Follicular lymphoma |
| C82.0 | Follicular lymphoma grade I |
| C82.00 | Follicular lymphoma grade i, unspecified site |
| C82.01 | Follicular lymphoma grade i, lymph nodes of head, face, and neck |
| C82.02 | Follicular lymphoma grade i, intrathoracic lymph nodes |
| C82.03 | Follicular lymphoma grade i, intra-abdominal lymph nodes |
| C82.04 | Follicular lymphoma grade i, lymph nodes of axilla and upper limb |
| C82.05 | Follicular lymphoma grade i, lymph nodes of inguinal region and lower limb |
| C82.06 | Follicular lymphoma grade i, intrapelvic lymph nodes |
| C82.07 | Follicular lymphoma grade i, spleen |
| C82.08 | Follicular lymphoma grade i, lymph nodes of multiple sites |
| C82.09 | Follicular lymphoma grade i, extranodal and solid organ sites |
| C82.1 | Follicular lymphoma grade II |
| C82.10 | Follicular lymphoma grade Ii, unspecified site |
| C82.11 | Follicular lymphoma grade Ii, lymph nodes of head, face, and neck |
| C82.12 | Follicular lymphoma grade Ii, intrathoracic lymph nodes |
| C82.13 | Follicular lymphoma grade Ii, intra-abdominal lymph nodes |
| C82.14 | Follicular lymphoma grade Ii, lymph nodes of axilla and upper limb |
| C82.15 | Follicular lymphoma grade Ii, lymph nodes of inguinal region and lower limb |
| C82.16 | Follicular lymphoma grade Ii, intrapelvic lymph nodes |
| C82.17 | Follicular lymphoma grade Ii, spleen |
| C82.18 | Follicular lymphoma grade Ii, lymph nodes of multiple sites |
| C82.19 | Follicular lymphoma grade Ii, extranodal and solid organ sites |
| C82.2 | Follicular lymphoma grade IIi, unspecified |
| C82.20 | Follicular lymphoma grade IIi, unspecified, unspecified site |
| C82.21 | Follicular lymphoma grade IIi, unspecified, lymph nodes of head, face, and neck |
| C82.22 | Follicular lymphoma grade IIi, unspecified, intrathoracic lymph nodes |
| C82.23 | Follicular lymphoma grade IIi, unspecified, intra-abdominal lymph nodes |
| C82.24 | Follicular lymphoma grade IIi, unspecified, lymph nodes of axilla and upper limb |
| C82.25 | Follicular lymphoma grade IIi, unspecified, lymph nodes of inguinal region and lower limb |
| C82.26 | Follicular lymphoma grade IIi, unspecified, intrapelvic lymph nodes |
| C82.27 | Follicular lymphoma grade IIi, unspecified, spleen |
| C82.28 | Follicular lymphoma grade IIi, unspecified, lymph nodes of multiple sites |
| C82.29 | Follicular lymphoma grade IIi, unspecified, extranodal and solid organ sites |
| C82.3 | Follicular lymphoma grade IIia |
| C82.30 | Follicular lymphoma grade IIia, unspecified site |
| C82.31 | Follicular lymphoma grade IIia, lymph nodes of head, face, and neck |
| C82.32 | Follicular lymphoma grade IIia, intrathoracic lymph nodes |
| C82.33 | Follicular lymphoma grade IIia, intra-abdominal lymph nodes |
| C82.34 | Follicular lymphoma grade IIia, lymph nodes of axilla and upper limb |
| C82.35 | Follicular lymphoma grade IIia, lymph nodes of inguinal region and lower limb |
| C82.36 | Follicular lymphoma grade IIia, intrapelvic lymph nodes |
| C82.37 | Follicular lymphoma grade IIia, spleen |
| C82.38 | Follicular lymphoma grade IIia, lymph nodes of multiple sites |
| C82.39 | Follicular lymphoma grade IIia, extranodal and solid organ sites |
| C82.4 | Follicular lymphoma grade IIib |
| C82.40 | Follicular lymphoma grade IIib, unspecified site |
| C82.41 | Follicular lymphoma grade IIib, lymph nodes of head, face, and neck |
| C82.42 | Follicular lymphoma grade IIib, intrathoracic lymph nodes |
| C82.43 | Follicular lymphoma grade IIib, intra-abdominal lymph nodes |
| C82.44 | Follicular lymphoma grade IIib, lymph nodes of axilla and upper limb |
| C82.45 | Follicular lymphoma grade IIib, lymph nodes of inguinal region and lower limb |
| C82.46 | Follicular lymphoma grade IIib, intrapelvic lymph nodes |
| C82.47 | Follicular lymphoma grade IIib, spleen |
| C82.48 | Follicular lymphoma grade IIib, lymph nodes of multiple sites |
| C82.49 | Follicular lymphoma grade IIib, extranodal and solid organ sites |
| C82.5 | Diffuse follicle center lymphoma |
| C82.50 | Diffuse follicle center lymphoma, unspecified site |
| C82.51 | Diffuse follicle center lymphoma, lymph nodes of head, face, and neck |
| C82.52 | Diffuse follicle center lymphoma, intrathoracic lymph nodes |
| C82.53 | Diffuse follicle center lymphoma, intra-abdominal lymph nodes |
| C82.54 | Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb |
| C82.55 | Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb |
| C82.56 | Diffuse follicle center lymphoma, intrapelvic lymph nodes |
| C82.57 | Diffuse follicle center lymphoma, spleen |
| C82.58 | Diffuse follicle center lymphoma, lymph nodes of multiple sites |
| C82.59 | Diffuse follicle center lymphoma, extranodal and solid organ sites |
| C82.6 | Cutaneous follicle center lymphoma |
| C82.60 | Cutaneous follicle center lymphoma, unspecified site |
| C82.61 | Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck |
| C82.62 | Cutaneous follicle center lymphoma, intrathoracic lymph nodes |
| C82.63 | Cutaneous follicle center lymphoma, intra-abdominal lymph nodes |
| C82.64 | Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb |
| C82.65 | Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb |
| C82.66 | Cutaneous follicle center lymphoma, intrapelvic lymph nodes |
| C82.67 | Cutaneous follicle center lymphoma, spleen |
| C82.68 | Cutaneous follicle center lymphoma, lymph nodes of multiple sites |
| C82.69 | Cutaneous follicle center lymphoma, extranodal and solid organ sites |
| C82.8 | Other types of follicular lymphoma |
| C82.80 | Other types of follicular lymphoma, unspecified site |
| C82.81 | Other types of follicular lymphoma, lymph nodes of head, face, and neck |
| C82.82 | Other types of follicular lymphoma, intrathoracic lymph nodes |
| C82.83 | Other types of follicular lymphoma, intra-abdominal lymph nodes |
| C82.84 | Other types of follicular lymphoma, lymph nodes of axilla and upper limb |
| C82.85 | Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb |
| C82.86 | Other types of follicular lymphoma, intrapelvic lymph nodes |
| C82.87 | Other types of follicular lymphoma, spleen |
| C82.88 | Other types of follicular lymphoma, lymph nodes of multiple sites |
| C82.89 | Other types of follicular lymphoma, extranodal and solid organ sites |
| C82.9 | Follicular lymphoma, unspecified |
| C82.90 | Follicular lymphoma, unspecified, unspecified site |
| C82.91 | Follicular lymphoma, unspecified, lymph nodes of head, face, and neck |
| C82.92 | Follicular lymphoma, unspecified, intrathoracic lymph nodes |
| C82.93 | Follicular lymphoma, unspecified, intra-abdominal lymph nodes |
| C82.94 | Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C82.95 | Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C82.96 | Follicular lymphoma, unspecified, intrapelvic lymph nodes |
| C82.97 | Follicular lymphoma, unspecified, spleen |
| C82.98 | Follicular lymphoma, unspecified, lymph nodes of multiple sites |
| C82.99 | Follicular lymphoma, unspecified, extranodal and solid organ sites |
| C83 | Non-follicular lymphoma |
| C83.0 | Small cell b-cell lymphoma |
| C83.00 | Small cell b-cell lymphoma, unspecified site |
| C83.01 | Small cell b-cell lymphoma, lymph nodes of head, face, and neck |
| C83.02 | Small cell b-cell lymphoma, intrathoracic lymph nodes |
| C83.03 | Small cell b-cell lymphoma, intra-abdominal lymph nodes |
| C83.04 | Small cell b-cell lymphoma, lymph nodes of axilla and upper limb |
| C83.05 | Small cell b-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C83.06 | Small cell b-cell lymphoma, intrapelvic lymph nodes |
| C83.07 | Small cell b-cell lymphoma, spleen |
| C83.08 | Small cell b-cell lymphoma, lymph nodes of multiple sites |
| C83.09 | Small cell b-cell lymphoma, extranodal and solid organ sites |
| C83.1 | Mantle cell lymphoma |
| C83.10 | Mantle cell lymphoma, unspecified site |
| C83.11 | Mantle cell lymphoma, lymph nodes of head, face, and neck |
| C83.12 | Mantle cell lymphoma, intrathoracic lymph nodes |
| C83.13 | Mantle cell lymphoma, intra-abdominal lymph nodes |
| C83.14 | Mantle cell lymphoma, lymph nodes of axilla and upper limb |
| C83.15 | Mantle cell lymphoma, lymph nodes of inguinal region and lower limb |
| C83.16 | Mantle cell lymphoma, intrapelvic lymph nodes |
| C83.17 | Mantle cell lymphoma, spleen |
| C83.18 | Mantle cell lymphoma, lymph nodes of multiple sites |
| C83.19 | Mantle cell lymphoma, extranodal and solid organ sites |
| C83.3 | Diffuse large b-cell lymphoma |
| C83.30 | Diffuse large b-cell lymphoma, unspecified site |
| C83.31 | Diffuse large b-cell lymphoma, lymph nodes of head, face, and neck |
| C83.32 | Diffuse large b-cell lymphoma, intrathoracic lymph nodes |
| C83.33 | Diffuse large b-cell lymphoma, intra-abdominal lymph nodes |
| C83.34 | Diffuse large b-cell lymphoma, lymph nodes of axilla and upper limb |
| C83.35 | Diffuse large b-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C83.36 | Diffuse large b-cell lymphoma, intrapelvic lymph nodes |
| C83.37 | Diffuse large b-cell lymphoma, spleen |
| C83.38 | Diffuse large b-cell lymphoma, lymph nodes of multiple sites |
| C83.39 | Diffuse large b-cell lymphoma, extranodal and solid organ sites |
| C83.5 | Lymphoblastic (diffuse) lymphoma |
| C83.50 | Lymphoblastic (diffuse) lymphoma, unspecified site |
| C83.51 | Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck |
| C83.52 | Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes |
| C83.53 | Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes |
| C83.54 | Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb |
| C83.55 | Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb |
| C83.56 | Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes |
| C83.57 | Lymphoblastic (diffuse) lymphoma, spleen |
| C83.58 | Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites |
| C83.59 | Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites |
| C83.7 | Burkitt lymphoma |
| C83.70 | Burkitt lymphoma, unspecified site |
| C83.71 | Burkitt lymphoma, lymph nodes of head, face, and neck |
| C83.72 | Burkitt lymphoma, intrathoracic lymph nodes |
| C83.73 | Burkitt lymphoma, intra-abdominal lymph nodes |
| C83.74 | Burkitt lymphoma, lymph nodes of axilla and upper limb |
| C83.75 | Burkitt lymphoma, lymph nodes of inguinal region and lower limb |
| C83.76 | Burkitt lymphoma, intrapelvic lymph nodes |
| C83.77 | Burkitt lymphoma, spleen |
| C83.78 | Burkitt lymphoma, lymph nodes of multiple sites |
| C83.79 | Burkitt lymphoma, extranodal and solid organ sites |
| C83.8 | Other non-follicular lymphoma |
| C83.80 | Other non-follicular lymphoma, unspecified site |
| C83.81 | Other non-follicular lymphoma, lymph nodes of head, face, and neck |
| C83.82 | Other non-follicular lymphoma, intrathoracic lymph nodes |
| C83.83 | Other non-follicular lymphoma, intra-abdominal lymph nodes |
| C83.84 | Other non-follicular lymphoma, lymph nodes of axilla and upper limb |
| C83.85 | Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb |
| C83.86 | Other non-follicular lymphoma, intrapelvic lymph nodes |
| C83.87 | Other non-follicular lymphoma, spleen |
| C83.88 | Other non-follicular lymphoma, lymph nodes of multiple sites |
| C83.89 | Other non-follicular lymphoma, extranodal and solid organ sites |
| C83.9 | Non-follicular (diffuse) lymphoma, unspecified |
| C83.90 | Non-follicular (diffuse) lymphoma, unspecified, unspecified site |
| C83.91 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck |
| C83.92 | Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes |
| C83.93 | Non-follicular (diffuse) lymphoma, unspecified, intra-abdominal lymph nodes |
| C83.94 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C83.95 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C83.96 | Non-follicular (diffuse) lymphoma, unspecified, intrapelvic lymph nodes |
| C83.97 | Non-follicular (diffuse) lymphoma, unspecified, spleen |
| C83.98 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of multiple sites |
| C83.99 | Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites |
| C84 | Mature t/Nk-cell lymphomas |
| C84.0 | Mycosis fungoides |
| C84.00 | Mycosis fungoides, unspecified site |
| C84.01 | Mycosis fungoides, lymph nodes of head, face, and neck |
| C84.02 | Mycosis fungoides, intrathoracic lymph nodes |
| C84.03 | Mycosis fungoides, intra-abdominal lymph nodes |
| C84.04 | Mycosis fungoides, lymph nodes of axilla and upper limb |
| C84.05 | Mycosis fungoides, lymph nodes of inguinal region and lower limb |
| C84.06 | Mycosis fungoides, intrapelvic lymph nodes |
| C84.07 | Mycosis fungoides, spleen |
| C84.08 | Mycosis fungoides, lymph nodes of multiple sites |
| C84.09 | Mycosis fungoides, extranodal and solid organ sites |
| C84.1 | Sezary disease |
| C84.10 | Sezary disease, unspecified site |
| C84.11 | Sezary disease, lymph nodes of head, face, and neck |
| C84.12 | Sezary disease, intrathoracic lymph nodes |
| C84.13 | Sezary disease, intra-abdominal lymph nodes |
| C84.14 | Sezary disease, lymph nodes of axilla and upper limb |
| C84.15 | Sezary disease, lymph nodes of inguinal region and lower limb |
| C84.16 | Sezary disease, intrapelvic lymph nodes |
| C84.17 | Sezary disease, spleen |
| C84.18 | Sezary disease, lymph nodes of multiple sites |
| C84.19 | Sezary disease, extranodal and solid organ sites |
| C84.4 | Peripheral t-cell lymphoma, not elsewhere classified |
| C84.40 | Peripheral t-cell lymphoma, not elsewhere classified, unspecified site |
| C84.41 | Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck |
| C84.42 | Peripheral t-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes |
| C84.43 | Peripheral t-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes |
| C84.44 | Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of axilla and upper limb |
| C84.45 | Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of inguinal region and lower limb |
| C84.46 | Peripheral t-cell lymphoma, not elsewhere classified, intrapelvic lymph nodes |
| C84.47 | Peripheral t-cell lymphoma, not elsewhere classified, spleen |
| C84.48 | Peripheral t-cell lymphoma, not elsewhere classified, lymph nodes of multiple sites |
| C84.49 | Peripheral t-cell lymphoma, not elsewhere classified, extranodal and solid organ sites |
| C84.6 | Anaplastic large cell lymphoma, ALk-positive |
| C84.60 | Anaplastic large cell lymphoma, ALk-positive, unspecified site |
| C84.61 | Anaplastic large cell lymphoma, ALk-positive, lymph nodes of head, face, and neck |
| C84.62 | Anaplastic large cell lymphoma, ALk-positive, intrathoracic lymph nodes |
| C84.63 | Anaplastic large cell lymphoma, ALk-positive, intra-abdominal lymph nodes |
| C84.64 | Anaplastic large cell lymphoma, ALk-positive, lymph nodes of axilla and upper limb |
| C84.65 | Anaplastic large cell lymphoma, ALk-positive, lymph nodes of inguinal region and lower limb |
| C84.66 | Anaplastic large cell lymphoma, ALk-positive, intrapelvic lymph nodes |
| C84.67 | Anaplastic large cell lymphoma, ALk-positive, spleen |
| C84.68 | Anaplastic large cell lymphoma, ALk-positive, lymph nodes of multiple sites |
| C84.69 | Anaplastic large cell lymphoma, ALk-positive, extranodal and solid organ sites |
| C84.7 | Anaplastic large cell lymphoma, ALk-negative |
| C84.70 | Anaplastic large cell lymphoma, ALk-negative, unspecified site |
| C84.71 | Anaplastic large cell lymphoma, ALk-negative, lymph nodes of head, face, and neck |
| C84.72 | Anaplastic large cell lymphoma, ALk-negative, intrathoracic lymph nodes |
| C84.73 | Anaplastic large cell lymphoma, ALk-negative, intra-abdominal lymph nodes |
| C84.74 | Anaplastic large cell lymphoma, ALk-negative, lymph nodes of axilla and upper limb |
| C84.75 | Anaplastic large cell lymphoma, ALk-negative, lymph nodes of inguinal region and lower limb |
| C84.76 | Anaplastic large cell lymphoma, ALk-negative, intrapelvic lymph nodes |
| C84.77 | Anaplastic large cell lymphoma, ALk-negative, spleen |
| C84.78 | Anaplastic large cell lymphoma, ALk-negative, lymph nodes of multiple sites |
| C84.79 | Anaplastic large cell lymphoma, ALk-negative, extranodal and solid organ sites |
| C84.7A | Anaplastic large cell lymphoma, ALk-negative, breast |
| C84.9 | Mature t/Nk-cell lymphomas, unspecified |
| C84.90 | Mature t/Nk-cell lymphomas, unspecified, unspecified site |
| C84.91 | Mature t/Nk-cell lymphomas, unspecified, lymph nodes of head, face, and neck |
| C84.92 | Mature t/Nk-cell lymphomas, unspecified, intrathoracic lymph nodes |
| C84.93 | Mature t/Nk-cell lymphomas, unspecified, intra-abdominal lymph nodes |
| C84.94 | Mature t/Nk-cell lymphomas, unspecified, lymph nodes of axilla and upper limb |
| C84.95 | Mature t/Nk-cell lymphomas, unspecified, lymph nodes of inguinal region and lower limb |
| C84.96 | Mature t/Nk-cell lymphomas, unspecified, intrapelvic lymph nodes |
| C84.97 | Mature t/Nk-cell lymphomas, unspecified, spleen |
| C84.98 | Mature t/Nk-cell lymphomas, unspecified, lymph nodes of multiple sites |
| C84.99 | Mature t/Nk-cell lymphomas, unspecified, extranodal and solid organ sites |
| C84.A | Cutaneous t-cell lymphoma, unspecified |
| C84.A0 | Cutaneous t-cell lymphoma, unspecified, unspecified site |
| C84.A1 | Cutaneous t-cell lymphoma, unspecified lymph nodes of head, face, and neck |
| C84.A2 | Cutaneous t-cell lymphoma, unspecified, intrathoracic lymph nodes |
| C84.A3 | Cutaneous t-cell lymphoma, unspecified, intra-abdominal lymph nodes |
| C84.A4 | Cutaneous t-cell lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C84.A5 | Cutaneous t-cell lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C84.A6 | Cutaneous t-cell lymphoma, unspecified, intrapelvic lymph nodes |
| C84.A7 | Cutaneous t-cell lymphoma, unspecified, spleen |
| C84.A8 | Cutaneous t-cell lymphoma, unspecified, lymph nodes of multiple sites |
| C84.A9 | Cutaneous t-cell lymphoma, unspecified, extranodal and solid organ sites |
| C84.Z | Other mature t/Nk-cell lymphomas |
| C84.Z0 | Other mature t/Nk-cell lymphomas, unspecified site |
| C84.Z1 | Other mature t/Nk-cell lymphomas, lymph nodes of head, face, and neck |
| C84.Z2 | Other mature t/Nk-cell lymphomas, intrathoracic lymph nodes |
| C84.Z3 | Other mature t/Nk-cell lymphomas, intra-abdominal lymph nodes |
| C84.Z4 | Other mature t/Nk-cell lymphomas, lymph nodes of axilla and upper limb |
| C84.Z5 | Other mature t/Nk-cell lymphomas, lymph nodes of inguinal region and lower limb |
| C84.Z6 | Other mature t/Nk-cell lymphomas, intrapelvic lymph nodes |
| C84.Z7 | Other mature t/Nk-cell lymphomas, spleen |
| C84.Z8 | Other mature t/Nk-cell lymphomas, lymph nodes of multiple sites |
| C84.Z9 | Other mature t/Nk-cell lymphomas, extranodal and solid organ sites |
| C85 | Other specified and unspecified types of non-hodgkin lymphoma |
| C85.1 | Unspecified b-cell lymphoma |
| C85.10 | Unspecified b-cell lymphoma, unspecified site |
| C85.11 | Unspecified b-cell lymphoma, lymph nodes of head, face, and neck |
| C85.12 | Unspecified b-cell lymphoma, intrathoracic lymph nodes |
| C85.13 | Unspecified b-cell lymphoma, intra-abdominal lymph nodes |
| C85.14 | Unspecified b-cell lymphoma, lymph nodes of axilla and upper limb |
| C85.15 | Unspecified b-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C85.16 | Unspecified b-cell lymphoma, intrapelvic lymph nodes |
| C85.17 | Unspecified b-cell lymphoma, spleen |
| C85.18 | Unspecified b-cell lymphoma, lymph nodes of multiple sites |
| C85.19 | Unspecified b-cell lymphoma, extranodal and solid organ sites |
| C85.2 | Mediastinal (thymic) large b-cell lymphoma |
| C85.20 | Mediastinal (thymic) large b-cell lymphoma, unspecified site |
| C85.21 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of head, face, and neck |
| C85.22 | Mediastinal (thymic) large b-cell lymphoma, intrathoracic lymph nodes |
| C85.23 | Mediastinal (thymic) large b-cell lymphoma, intra-abdominal lymph nodes |
| C85.24 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of axilla and upper limb |
| C85.25 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of inguinal region and lower limb |
| C85.26 | Mediastinal (thymic) large b-cell lymphoma, intrapelvic lymph nodes |
| C85.27 | Mediastinal (thymic) large b-cell lymphoma, spleen |
| C85.28 | Mediastinal (thymic) large b-cell lymphoma, lymph nodes of multiple sites |
| C85.29 | Mediastinal (thymic) large b-cell lymphoma, extranodal and solid organ sites |
| C85.8 | Other specified types of non-hodgkin lymphoma |
| C85.80 | Other specified types of non-hodgkin lymphoma, unspecified site |
| C85.81 | Other specified types of non-hodgkin lymphoma, lymph nodes of head, face, and neck |
| C85.82 | Other specified types of non-hodgkin lymphoma, intrathoracic lymph nodes |
| C85.83 | Other specified types of non-hodgkin lymphoma, intra-abdominal lymph nodes |
| C85.84 | Other specified types of non-hodgkin lymphoma, lymph nodes of axilla and upper limb |
| C85.85 | Other specified types of non-hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
| C85.86 | Other specified types of non-hodgkin lymphoma, intrapelvic lymph nodes |
| C85.87 | Other specified types of non-hodgkin lymphoma, spleen |
| C85.88 | Other specified types of non-hodgkin lymphoma, lymph nodes of multiple sites |
| C85.89 | Other specified types of non-hodgkin lymphoma, extranodal and solid organ sites |
| C85.9 | Non-hodgkin lymphoma, unspecified |
| C85.90 | Non-hodgkin lymphoma, unspecified, unspecified site |
| C85.91 | Non-hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck |
| C85.92 | Non-hodgkin lymphoma, unspecified, intrathoracic lymph nodes |
| C85.93 | Non-hodgkin lymphoma, unspecified, intra-abdominal lymph nodes |
| C85.94 | Non-hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb |
| C85.95 | Non-hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
| C85.96 | Non-hodgkin lymphoma, unspecified, intrapelvic lymph nodes |
| C85.97 | Non-hodgkin lymphoma, unspecified, spleen |
| C85.98 | Non-hodgkin lymphoma, unspecified, lymph nodes of multiple sites |
| C85.99 | Non-hodgkin lymphoma, unspecified, extranodal and solid organ sites |
| C86 | Other specified types of t/Nk-cell lymphoma |
| C86.0 | Extranodal Nk/t-cell lymphoma, nasal type |
| C86.1 | Hepatosplenic t-cell lymphoma |
| C86.2 | Enteropathy-type (intestinal) t-cell lymphoma |
| C86.3 | Subcutaneous panniculitis-like t-cell lymphoma |
| C86.4 | Blastic Nk-cell lymphoma |
| C86.5 | Angioimmunoblastic t-cell lymphoma |
| C86.6 | Primary cutaneous Cd30-positive t-cell proliferations |
| C88.0 | Waldenstrom macroglobulinemia |
| C88.4 | Extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue [MALt-lymphoma] |
| C91.5 | Adult t-cell lymphoma/leukemia (HTLv-1-associated) |
| C91.50 | Adult t-cell lymphoma/leukemia (HTLv-1-associated) not having achieved remission |
Formulary Reference Tool