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CSC BMT Inpt Melphalan High Dose (D-2) VER 11-17-17 (HL 1009)

CSC BMT Inpt Melphalan High Dose (D-2) VER 11-17-17 (HL 1009) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT INPT MELPHALAN HIGH DOSE (D-2) VER: 11-17-17 –  Properties
Conditioning Regimen prior to BMT –  11/16/2017 through 11/23/2017 (8 days), Planned
Treatment Orders for Day -2 to Day 0, Conditioning Regimen prior to BMT –  Planned for
11/16/2017
Treatment Plan Information
Reference Information (1)
BMT (Autologous): Attal M, et al. N Engl J Med 2003;349.
Reference Information (2)
BMT (Autologous): Shah N, et al. Biol Blood Marrow Transplant 2015;21(7):1155-66.
Treatment Plan Summary
DISEASE: Multiple Myeloma
THERAPY: melphalan 200 mg/m2 IV Day -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.
Treatment Conditions
Verify Labs
Verify labs from BMT Admission Order Set with authorizing prescriber prior to releasing treatment medications and
document in a progress note.
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".
Hydration
sodium chloride 0.9 % infusion
Intravenous, CONTINUOUS Starting when released Until Discontinued
Day -2: Start prior to melphalan. Administer at 2 L/m2/day.
Pre-Medications
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
150 mg, Intravenous, ONCE, 1 dose Starting when released
Day-2: 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 -2: Administer 30 minutes prior to melphalan.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, PRN Starting when released Until Discontinued, nausea/vomiting, if unable to tolerate PO
Day -2: Administer 30 minutes prior to melphalan.
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Zztestonc,Jeff J [2507481]
11/16/2017 12:03:33 PM Page 1 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, EVERY 24 HOURS, 4 doses Starting when released
Day -2 and Day -1, Day 0 AND DAY 1: Administer first dose prior to melphalan.
Conditional Orders
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 72 hours Starting when released, nausea/vomiting, If unable to tolerate
PO
Day -2 through Day 1: Administer first dose prior to melphalan.
Pre-Medications
olanzapine (ZYPREXA) tab 5 mg
5 mg, Oral, ONCE, 1 dose Starting when released
Day -2. Administer 30 minutes prior to melphalan.
Treatment Medications
melphalan (ALKERAN) injection 392 mg
392 mg (200 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released, Administer over 15 Minutes
Day -2: Administer over 15 minutes. 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.
Supportive Care Medications
olanzapine (ZYPREXA) tab 5 mg
5 mg, Oral, 1 X DAILY (HS), 3 doses Starting S+1 As Scheduled
Days -1 through Day 1
Take Home Medications
olanzapine (ZYPREXA) 5 MG tab
Take 1 tab by mouth one time daily at bedtime. Day 0 and Day +1., 5 mg, Disp-2 tab, R-0, 1 X DAILY (HS) starting S,
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Zztestonc,Jeff J [2507481]
11/16/2017 12:03:33 PM Page 2 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org