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CSC BMT Fludarabine-Busulfan-ATG (RABBIT) VER 4-11-17 (HL 4357)

CSC BMT Fludarabine-Busulfan-ATG (RABBIT) VER 4-11-17 (HL 4357) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT FLUDARABINE/BUSULFAN/ATG(RABBIT) VER: 4-11-17 – Properties
Cycle 1 – 4/11/2017 through 4/18/2017 (8 days), Planned
Treatment Orders for Transplant Day -7 (Outpatient), Cycle 1 – Planned for 4/11/2017
Treatment Plan Information
Reference Information (1)
BMT: Andersson BS, et al. Biol Blood Marrow Transplant 2008;14:672-84
Reference Information (2)
BMT: Mohty M, et al. Blood 2003;102:470-6
Reference Information (3)
BMT: deLima M, et al. Blood 2004:104:857-64
Reference Information (4)
BMT: Bornhauser M,et al. Blood 2003:102:820-6
Reference Information (5)
BMT: Devine SM, et al. J Clin Onc 2015;33(35):4167-78.
Treatment Plan Summary
DISEASE: Acute Myelogenous Leukemia (AML), Myelodysplastic Syndrome (MDS), Myeloproliferative Neoplasms (MPN) and Acute
Lymphocytic Leukemia (ALL); THERAPY: fludarabine 30 mg/m2 IV daily Day -7,-6,-5,-4 and -3, busulfan 0.8 mg/kg IV every 6 hours
on Day -4 and Day -3 (Total of 8 doses), antithymocyte globulin (rabbit) 2.5 mg/kg IV daily Days -4, -3 and -2; CYCLE LENGTH: 8
days; COURSE: 1 cycle; GVHD PROPHYLAXIS: tacrolimus 0.045 mg/kg by mouth twice daily starting Day -3, methotrexate 5
mg/m2 IV once daily on Days +1, +3, +6, and +11. GROWTH FACTOR REQUIRED.
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
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 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
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ZZtestonc,Andrew [2428787]
4/11/2017 3:33:05 PM Page 1 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

fludarabine (FLUDARA) 30 mg/m2 in sodium chloride 0.9 % 100 mL bag
30 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 30 minutes
Take Home Medications
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
levetiracetam (KEPPRA) 500 MG tab
Take 1 tab by mouth 2 times daily. Day -5 through Day 0., 500 mg, Disp-12 tab, R-0, 2 X DAILY starting S, Local Printer
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
Day -6, CHEMOTHERAPY ROOM APPOINTMENT : fludarabine infusion for 60 minutes
MULTIPLE DAY FOLLOW-UP (2)
Day -5, CHEMOTHERAPY ROOM APPOINTMENT : fludarabine infusion for 60 minutes
MULTIPLE DAY FOLLOW-UP (3)
Day -4, Inpatient admission to B6/6
Treatment Orders for Transplant Day -6 (Outpatient), Cycle 1 – Planned for 4/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Acute Myelogenous Leukemia (AML), Myelodysplastic Syndrome (MDS), Myeloproliferative Neoplasms (MPN) and Acute
Lymphocytic Leukemia (ALL); THERAPY: fludarabine 30 mg/m2 IV daily Day -7,-6,-5,-4 and -3, busulfan 0.8 mg/kg IV every 6 hours
on Day -4 and Day -3 (Total of 8 doses), antithymocyte globulin (rabbit) 2.5 mg/kg IV daily Days -4, -3 and -2; CYCLE LENGTH: 8
days; COURSE: 1 cycle; GVHD PROPHYLAXIS: tacrolimus 0.045 mg/kg by mouth twice daily starting Day -3, methotrexate 5
mg/m2 IV once daily on Days +1, +3, +6, and +11. GROWTH FACTOR REQUIRED.
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
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 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
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ZZtestonc,Andrew [2428787]
4/11/2017 3:33:05 PM Page 2 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

fludarabine (FLUDARA) 30 mg/m2 in sodium chloride 0.9 % 100 mL bag
30 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 30 minutes
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Treatment Orders for Transplant Day -5 (Outpatient), Cycle 1 – Planned for 4/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Acute Myelogenous Leukemia (AML), Myelodysplastic Syndrome (MDS), Myeloproliferative Neoplasms (MPN) and Acute
Lymphocytic Leukemia (ALL); THERAPY: fludarabine 30 mg/m2 IV daily Day -7,-6,-5,-4 and -3, busulfan 0.8 mg/kg IV every 6 hours
on Day -4 and Day -3 (Total of 8 doses), antithymocyte globulin (rabbit) 2.5 mg/kg IV daily Days -4, -3 and -2; CYCLE LENGTH: 8
days; COURSE: 1 cycle; GVHD PROPHYLAXIS: tacrolimus 0.045 mg/kg by mouth twice daily starting Day -3, methotrexate 5
mg/m2 IV once daily on Days +1, +3, +6, and +11. GROWTH FACTOR REQUIRED.
Treatment Conditions
Verify Medication(s) Taken at Home (1)
Verify that patient has taken levetiracetam and document in a progress note. Notify authorizing prescriber if patient has not taken
medication as prescribed.
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
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 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, ONCE, 1 dose Starting when released
Give prior to chemotherapy.
Treatment Medications
fludarabine (FLUDARA) 30 mg/m2 in sodium chloride 0.9 % 100 mL bag
30 mg/m2, Intravenous, ONCE, 1 dose Starting when released
Administer over 30 minutes
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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ZZtestonc,Andrew [2428787]
4/11/2017 3:33:05 PM Page 3 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

Treatment Orders for Transplant Days -4 Through +12 (Inpatient), Cycle 1 – Planned for 4/14/2017
through 4/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Acute Myelogenous Leukemia (AML), Myelodysplastic Syndrome (MDS), Myeloproliferative Neoplasms (MPN) and Acute
Lymphocytic Leukemia (ALL); THERAPY: fludarabine 30 mg/m2 IV daily Day -7,-6,-5,-4 and -3, busulfan 0.8 mg/kg IV every 6 hours
on Day -4 and Day -3 (Total of 8 doses), antithymocyte globulin (rabbit) 2.5 mg/kg IV daily Days -4, -3 and -2; CYCLE LENGTH: 8
days; COURSE: 1 cycle; GVHD PROPHYLAXIS: tacrolimus 0.045 mg/kg by mouth twice daily starting Day -3, methotrexate 5
mg/m2 IV once daily on Days +1, +3, +6, and +11. GROWTH FACTOR REQUIRED.
Consent
Verify Consent
Verify informed consent has been obtained.
Additional Labs
METHOTREXATE
ONCE Starting S+11 at 0000
METHOTREXATE
ONCE Starting S+16 at 0000
Treatment Conditions
Verify Medication(s) Taken at Home (1)
Verify that patient has taken levetiracetam and document in a progress note. Notify authorizing prescriber if patient has not taken
medication as prescribed.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to antithymocyte globulin RABBIT can occur. See Emergency Medications.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Take vital signs prior to each antithymocyte globulin (rabbit) dose, then every 30 minutes x 2 (for the first hour), then every hour
during the infusion and every hour x 2 hours after the infusion is complete
Hydration
sodium chloride 0.9 % infusion
Intravenous, CONTINUOUS Starting when released Until Discontinued
Start hydration on Day -4 and continue throughout busulfan administration. Dose = 1.5 L/m2/day
Pre-Medications
ondansetron (ZOFRAN) tab 12 mg
12 mg, Oral, 1 X DAILY, 2 doses Starting when released
Day -4 and -3. Administer prior to chemotherapy
ondansetron (ZOFRAN) 12 mg in sodium chloride 0.9 % 50 mL bag
12 mg, Intravenous, 1 X DAILY PRN, For 3 days Starting when released until S+3, nausea/vomiting, if unable to tolerate PO
If unable to tolerate oral dose
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day -4, -3 and -2. Administer at least 30 minutes prior to ATG
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, EVERY 24 HOURS, 3 doses Starting when released, Administer over 1 Minutes
Day -4, -3 and -2. Administer at least 30 minutes prior to ATG
methylprednisolone sod. succ. in sodium chloride 0.9% (SOLU-MEDROL) bag 1 mg/kg (Treatment Plan)
1 mg/kg, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day -4, -3 and -2. Administer at least 30 minutes prior to ATG
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
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ZZtestonc,Andrew [2428787]
4/11/2017 3:33:05 PM Page 4 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
antithymocyte globulin RABBIT (THYMOGLOBULIN) 2.5 mg/kg in sodium chloride 0.9 % 250 mL bag CENTRAL
2.5 mg/kg, Intravenous, EVERY 24 HOURS, 3 doses Starting when released
Day -4, -3, and -2. Administer over 4 hours. Use 0.2 or 0.22 micron in-line filter during administration.
fludarabine (FLUDARA) 30 mg/m2 in sodium chloride 0.9 % 100 mL bag
30 mg/m2, Intravenous, EVERY 24 HOURS, 2 doses Starting when released
Day -4 and -3. Administer over 30 minutes
busulfan (BUSULFEX) 0.8 mg/kg in sodium chloride 0.9 % 100 mL bag
0.8 mg/kg, Intravenous, EVERY 6 HOURS, 8 doses Starting when released
Day -4 and -3. Administer over 120 minutes
methotrexate PF (TREXALL) injection 5 mg/m2 (Treatment Plan)
5 mg/m2, Intravenous, ONCE, 1 dose Starting S+5 at 0000
Day +1. Administer 24 hours after completion of stem cell infusion. IV push rate 10 mg/minute.
methotrexate PF (TREXALL) injection 5 mg/m2 (Treatment Plan)
5 mg/m2, Intravenous, ONCE, 1 dose Starting S+7 at 0000
Day +3. IV push rate 10 mg/minute. Check with BMT team before administering dose.
methotrexate PF (TREXALL) injection 5 mg/m2 (Treatment Plan)
5 mg/m2, Intravenous, ONCE, 1 dose Starting S+10 at 0000
Day +6. IV push rate 10 mg/minute. Check with BMT team before administering dose.
methotrexate PF (TREXALL) injection 5 mg/m2 (Treatment Plan)
5 mg/m2, Intravenous, ONCE, 1 dose Starting S+15 at 0000
Day +11. IV push rate 10 mg/minute. Check with BMT team before administering dose.
tacrolimus cap
Oral, 2 X DAILY Starting S+1 As Scheduled
Dose = 0.045 mg/kg twice daily based on Treatment Plan Actual Weight. Starting Day -3
Conditional Orders
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, EVERY 6 HOURS PRN, For 4 days Starting when released, fever, infusion reaction
Supportive Care Medications
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Subcutaneous, 1 X DAILY (PM) Starting S+16 As Scheduled
For weight less than or equal to 80 kg dose = 300 mcg, for weight greater than 80 kg dose = 480 mcg. Start on Day +12
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ZZtestonc,Andrew [2428787]
4/11/2017 3:33:05 PM Page 5 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org