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CSC BMT-INPT CORD (Non-Myeloablative) Cyclophosphamide/Fludarabine/TBI VER 10-25-17 (HL 3159)

CSC BMT-INPT CORD (Non-Myeloablative) Cyclophosphamide/Fludarabine/TBI VER 10-25-17 (HL 3159) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT-INPT CORD (NON-MYELOABLATIVE) CYCLOPHOSPHAMIDE/FLUDARABINE/TBI VER: 10-25-
17 –  Properties
Cycle 1 –  10/26/2017 through 10/31/2017 (6 days), Planned
Day 1, Cycle 1 –  Planned for 10/26/2017
Treatment Plan Information
Reference Information (1)
UMBILICAL CORD BLOOD TRANSPLANT: Brunstein C, et al. Blood. 2007;110(8):3064-70.
Reference Information (2)
UMBILICAL CORD BLOOD TRANSPLANT: Brunstein CG, et al. Blood 2011;118(2):282-88.
Treatment Plan Summary
DISEASE: Hematologic Malignancies; THERAPY: fludarabine 40 mg/m2 IV Day -6 through -2, mesna 50 mg/kg IV Day -6,
cyclophosphamide 50 mg/kg IV Day -6, Total Body Irradiation 200 cGy Day -1; CYCLE LENGTH: 6 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 provider prior to releasing treatment medications and
document in a progress note.
Nursing Procedure, Assessment and Monitoring
Measure Intake And Output
EVERY 4 HOURS Starting when released Until Specified
Cyclophosphamide: Monitor urine output and notify BMT team if less than 400 mL over 4 hours.
Hydration
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
Intravenous, CONTINUOUS, For 2 days Starting when released until S+2
Day -6 to -5: IV fluid rate = 3 L/m2/day
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting S+2 at 0000 Until Discontinued
Start Day -4: Decrease IV fluid rate to 100 mL/hr.
Pre-Medications
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
150 mg, Intravenous, ONCE, 1 dose Starting when released
Give on Day -6 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
Give on Day -6 prior to chemotherapy. May give IV if unable to tolerate PO.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
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ZZtestonc,Andrew [2428787]
10/26/2017 11:40:44 AM Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

16 mg, Intravenous, ONCE PRN, For 2 days Starting when released until S+2, nausea/vomiting
Give if patient unable to tolerate PO on Day -6.
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, EVERY 24 HOURS, 4 doses Starting when released
Day -6, -5, -4, and -3. May give IV if unable to tolerate PO.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 4 days Starting when released until S+4
Days -6, -5, -4, and -3. Administer IV if unable to tolerate PO.
ondansetron (ZOFRAN) tab 12 mg
12 mg, Oral, EVERY 12 HOURS, 2 doses Starting S+5 at 0000
Give first dose prior to radiotherapy on Day -1. May give IV if unable to tolerate PO.
ondansetron (ZOFRAN) injection 12 mg
12 mg, Intravenous, EVERY 12 HOURS PRN, For 2 days Starting S+5 at 0000 until S+7, nausea/vomiting, Administer over
3 Minutes
Give if patient unable to tolerate PO on Day -1. Administer over 3 to 5 minutes.
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting S+5 at 0000
Give prior to radiotherapy on Day -1. May give IV if unable to tolerate PO.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, ONCE PRN, For 2 days Starting S+5 at 0000 until S+7, nausea/vomiting
Give if patient unable to tolerate PO on Day -1.
Treatment Medications
fludarabine (FLUDARA) 74 mg in sodium chloride 0.9 % 100 mL bag
74 mg (40 mg/m2 × 1.85 m2 Treatment plan BSA from recorded weight), Intravenous, EVERY 24 HOURS, 5 doses
Starting when released
Give on Day -6 through -2.
Decrease dose by 20% if Creatinine Clearance less than 70 mL/min/1.73 m2 or if patient has prior history of CNS
disease, brain radiation or intrathecal chemotherapy.
mesna (MESNEX) 3,075 mg in sodium chloride 0.9 % 1,000 mL bag
3,075 mg (50 mg/kg × 61.5 kg Treatment plan ideal weight), Intravenous, ONCE, 1 dose Starting when released
Give on Day -6. Begin 15 minutes prior to start of cyclophosphamide and infuse over 24 hours.
cyclophosphamide (CYTOXAN) 3,075 mg bag
3,075 mg (50 mg/kg × 61.5 kg Treatment plan ideal weight), Intravenous, ONCE, 1 dose Starting when released
Give on Day -6.
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Give 1 hour after start of cyclophosphamide on Day -6. IV push rate 10 mg/minute.
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, ONCE, 1 dose Starting when released
Give 6 hours after start of cyclophosphamide on Day -6. IV push rate 10 mg/minute.
cyclosporine (SANDIMMUNE) 225 mg in dextrose 5 % 250 mL bag
225 mg (3 mg/kg × 75 kg Treatment plan recorded weight), Intravenous, EVERY 24 HOURS Starting S+3 at 0000
Begin on Day -3. Adjust dose to achieve a therapeutic level of 136 to 282 ng/mL.
mycophenolate (CELLCEPT) 1,000 mg in dextrose 5 % 100 mL bag
1,000 mg, Intravenous, EVERY 8 HOURS Starting S+3 at 0000, Administer over 2 Hours
Administer over 120 minutes. Begin on Day -3. Dose = 15 mg/kg IV every 8 hours if patient weight is less than or equal
to 50 kg.
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Subcutaneous, 1 X DAILY (PM) Starting S+11 As Scheduled
Begin on D+5. Dose = 300 mcg (weight 80 kg). May discontinue when ANC is greater
than or equal to 2000/µL for 3 consecutive days.
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ZZtestonc,Andrew [2428787]
10/26/2017 11:40:44 AM Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 10/2017CCKM@uwhealth.org

Conditional Orders
diphenhydramine (BENADRYL) cap RANGE 25-50 mg
25-50 mg, Oral, EVERY 4 HOURS PRN, For 2 days Starting when released until S+2, nasal burning or discomfort
Give if patient experiences nasal burning or discomfort during cyclophosphamide infusion on Day -6.
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ZZtestonc,Andrew [2428787]
10/26/2017 11:40:44 AM Page 3 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
10/2017CCKM@uwhealth.org