The recommended dose of Lomustine in adult and pediatric patients as a single agent in previously untreated patients is 130 mg/m2 as a single oral dose every 6 weeks (see PRECAUTIONS: Information for Patients and HOW SUPPLIED: Directions to the Pharmacist). In individuals with compromised bone marrow function, the dose should be reduced to 100 mg/m2 every 6 weeks. When Lomustine is used in combination with other myelosuppressive drugs, the doses should be adjusted accordingly. All doses of Lomustine must be rounded to the nearest 10 mg by the prescriber (see HOW SUPPLIED).
Doses subsequent to the initial dose should be adjusted according to the hematologic response of the patient to the preceding dose. The following schedule is suggested as a guide to dosage adjustment:
Nadir After Prior Dose
Percentage of Prior Dose
to be Given
Leukocytes (/mm3)
Platelets (/mm3)
≥4000
≥100,000
100%
3000–3999
75,000–99,999
100%
2000–2999
25,000–74,999
70%
<2000
<25,000
50%
A repeat course of Lomustine should not be given until circulating blood elements have returned to acceptable levels (platelets above 100,000/mm3; leukocytes above 4000/mm3), and this is usually in 6 weeks. Adequate number of neutrophils should be present on a peripheral blood smear. Blood counts should be monitored weekly and repeat courses should not be given before 6 weeks because the hematologic toxicity is delayed and cumulative.
