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CSC BMT Outpt Melphalan High Dose (D-3,-2) VER 11-17-17 (HL 6534)

CSC BMT Outpt Melphalan High Dose (D-3,-2) VER 11-17-17 (HL 6534) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT OUTPT MELPHALAN HIGH DOSE (D-3,-2) VER: 11-17-17 –  Properties
Cycle 1 –  11/16/2017 through 11/18/2017 (3 days), Planned
Day -3, Cycle 1 –  Planned for 11/16/2017
Treatment Plan Information
Reference Information (1)
BMT (Autologous): Majolino I, et al. Haematologica 1993;78:68-71.
Reference Information (2)
BMT (Autologous): D'Souza A, et al. J Clin Oncol 2015;33(32):3741-49.
Reference Information (3)
BMT (Autologous): Hari P, et al. Biol Blood Marrow Transplant 2015;21:2100-05.
Treatment Plan Summary
DISEASE: Amyloidosis; THERAPY: melphalan 100 mg/m2 IV Day -3 and -2; CYCLE LENGTH: 3 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.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Verify Labs
Verify that the following labs have been obtained within the past 7 days: CBC with DIFF, Sodium, Potassium, Chloride,
Carbon Dioxide, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT and Alkaline
Phosphatase.
Patient Instructions(1)
RN instruct patient on cryotherapy to reduce incidence and severity of oral mucositis. Offer cryotherapy 10 minutes
before, during, and for a total of 60 minutes after melphalan administration. See Health Fact for You #7502 "Controlling
Mouth Sores from Melphalan".
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
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Zztestonc,Jeff J [2507481]
11/16/2017 1:38:39 PM Page 1 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Hydration
sodium chloride 0.9% BOLUS
1,000 mL, Intravenous, ONCE, 1 dose Starting when released
Infuse 500 mL prior to melphalan and 500 mL after melphalan.
Pre-Medications
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
150 mg, Intravenous, ONCE, 1 dose Starting when released
Administer over 30 minutes starting 30 minutes 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
Administer 30 minutes prior to chemotherapy. May use IV if unable to tolerate PO.
ondansetron (ZOFRAN) injection 16 mg
16 mg, Intravenous, EVERY 24 HOURS PRN, For 48 hours Starting when released, nausea/vomiting, if unable to take PO,
Administer over 3 Minutes
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Administer 30 minutes prior to chemotherapy. May us IV if unable to tolerate PO.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 48 hours Starting when released, nausea/vomiting, if unable to take PO
olanzapine (ZYPREXA) tab 5 mg
5 mg, Oral, ONCE, 1 dose Starting when released
Administer 30 minutes prior to chemotherapy.
Treatment Medications
melphalan (ALKERAN) injection 196 mg
196 mg (100 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released, Administer over 15 Minutes
Administer over 15 minutes. Round dose to nearest 50 mg vial. Pharmacist and RN must coordinate timing of
administration to allow administration of dose as close as possible to time of dose preparation due to poor stability and
short expiration of drug. Drug must be given within 60 minutes of reconstitution.
Take Home Medications
dexamethasone (DECADRON) 4 MG tab
Take 2 tablets on Day -1, Day 0 (prior to admission), and Day +1 (inpatient)., Disp-4 tab, R-0, starting S, Local Printer
olanzapine (ZYPREXA) 5 MG tab
Take 1 tab by mouth one time daily at bedtime. Take for 3 days starting the day after chemotherapy., 5 mg, Disp-3 tab,
R-0, 1 X DAILY (HS) starting S, Local Printer
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting., 10 mg, Disp-30 tab, R-5, EVERY 6 HOURS PRN
starting S, Local Printer
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
Day -2: RETURN TO CLINIC; CHEMOTHERAPY: melphalan for 60 minutes.
Verify preadmission to B6/6 for Stem Cell Transplantation on Day 0.
Day -2, Cycle 1 –  Planned for 11/17/2017
Treatment Plan Information
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Zztestonc,Jeff J [2507481]
11/16/2017 1:38:39 PM Page 2 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Amyloidosis; THERAPY: melphalan 100 mg/m2 IV Day -3 and -2; CYCLE LENGTH: 3 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.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
RN instruct patient on cryotherapy to reduce incidence and severity of oral mucositis. Offer cryotherapy 10 minutes
before, during, and for a total of 60 minutes after melphalan administration. See Health Fact for You #7502 "Controlling
Mouth Sores from Melphalan".
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9% BOLUS
1,000 mL, Intravenous, ONCE, 1 dose Starting when released
Infuse 500 mL prior to melphalan and 500 mL after melphalan.
Pre-Medications
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released
Administer 30 minutes prior to chemotherapy. May use IV if unable to tolerate PO.
ondansetron (ZOFRAN) injection 16 mg
16 mg, Intravenous, EVERY 24 HOURS PRN, For 48 hours Starting when released, nausea/vomiting, if unable to take PO,
Administer over 3 Minutes
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Administer 30 minutes prior to chemotherapy. May use IV if unable to tolerate PO.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 48 hours Starting when released, nausea/vomiting, if unable to take PO
olanzapine (ZYPREXA) tab 5 mg
5 mg, Oral, ONCE, 1 dose Starting when released
Administer 30 minutes prior to chemotherapy.
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Zztestonc,Jeff J [2507481]
11/16/2017 1:38:39 PM Page 3 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Treatment Medications
melphalan (ALKERAN) injection 196 mg
196 mg (100 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released, Administer over 15 Minutes
Administer over 15 minutes. Round dose to nearest 50 mg vial. Pharmacist and RN must coordinate timing of
administration to allow administration of dose as close as possible to time of dose preparation due to poor stability and
short expiration of drug. Drug must be given within 60 minutes of reconstitution.
Actions
Actions
Zztestonc,Jeff J [2507481]
11/16/2017 1:38:39 PM Page 4 of 4
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org