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CSC BMT INPT Carmustine Thiotepa VER 9-20-17 (HL 6233)

CSC BMT INPT Carmustine Thiotepa VER 9-20-17 (HL 6233) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT INPT CARMUSTINE/THIOTEPA VER: 9-20-17 –  Properties
Conditioning Regimen for Autologous Transplant –  9/20/2017 through 9/26/2017 (7 days), Planned
Treatment Orders Beginning Day -6, Conditioning Regimen for Autologous Transplant –  Planned
for 9/20/2017
Treatment Plan Information
Reference Information (1)
PCNSL: Citterio, G, et al. Crit Rev Oncol Hematol 2017;113:97-110. doi: 10.1016/j.critrevonc.2017.03.019
Reference Information (2)
PCNSL: Kasenda B, et al. Leukemia 2017 doi: 10.1038/leu.2017.170. [Epub ahead of print]
Reference Information (3)
PCNSL: Ferreri AJM, et al. Blood 2016;127(13):1642-49.
Treatment Plan Summary
DISEASE: PCNSL (Frontline, Relapsed/Refractory); THERAPY: carmustine 400 mg/m2 IV Day -6, thiotepa 5 mg/kg IV
every 12 hours Day -5 and -4; GROWTH FACTOR REQUIRED; CYCLE LENGTH: 7 days; COURSE: 1 cycle
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
Consent
Verify Consent
Verify informed consent has been obtained.
Hydration
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Start Day -6. Adjust rate as needed.
Pre-Medications
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
150 mg, Intravenous, ONCE, 1 dose Starting when released
Day -6. Administer prior to chemotherapy. Do not infuse with CA++, Mg++, Lactated Ringer's solutions
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Day -6. Administer prior to chemotherapy. If unable to tolerate PO may give IV.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, 1 X DAILY PRN, For 48 hours Starting when released, nausea/vomiting
Day -6. Administer prior to chemotherapy. If unable to tolerate PO may give IV.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released
Day -6. Administer prior to chemotherapy. If unable to tolerate PO may give IV.
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, 1 X DAILY PRN, For 48 hours Starting when released, nausea/vomiting
Day -6. If unable to tolerate PO may give IV.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 12 HOURS, 4 doses Starting S+1 at 0000
Day -5 and -4. Administer prior to thiotepa. If unable to tolerate PO may give IV.
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Zztestonc,Edward E [2435061]
9/20/2017 3:23:18 PM Page 1 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 09/2017CCKM@uwhealth.org

ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 12 HOURS PRN, For 72 hours Starting S+1 at 0000, nausea/vomiting, Administer over 3
Minutes
Day -5 and -4. If unable to tolerate PO may give IV.
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, 1 X DAILY, 3 doses Starting S+1 As Scheduled
Day -5, -4, -3. Administer prior to thiotepa. If unable to tolerate PO may give IV.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, 1 X DAILY PRN, For 96 hours Starting S+1 at 0000, nausea/vomiting
Day -5, -4, -3. If unable to tolerate PO may give IV.
Treatment Medications
carmustine (BiCNU) 400 mg/m2 in dextrose 5 % 500 mL non-PVC bag
400 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Day -6. Administer over 120 minutes.
thiotepa (THIOPLEX) 5 mg/kg in sodium chloride 0.9 % 250 mL bag
5 mg/kg, Intravenous, EVERY 12 HOURS, 4 doses Starting S+1 at 0000
Day -5 and -4: Administer over 3 hours.
Supportive Care Medications
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Subcutaneous, 1 X DAILY (PM) Starting S+10 As Scheduled
Start on Day +4. Discontinue when ANC is greater than 500/µL for 2 consecutive days.
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Zztestonc,Edward E [2435061]
9/20/2017 3:23:18 PM Page 2 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
09/2017CCKM@uwhealth.org