/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/bmt/,

/clinical/cckm-tools/content/beacon-protocols/bmt/name-96572-en.cckm

201710300

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,BMT

CSC BMT INPT Cyclophosphamide(D-7,-6)-TBI VER 7-6-17 (HL 4448)

CSC BMT INPT Cyclophosphamide(D-7,-6)-TBI VER 7-6-17 (HL 4448) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT INPT CYCLOPHOSPHAMIDE(D-7,-6)/TBI VER: 7-6-17 –  Properties
Conditioning Regimen prior to BMT –  7/6/2017 through 7/25/2017 (20 days), Planned
Treatment Orders for Day -7 through Day +11, Conditioning Regimen prior to BMT –  Planned for
7/6/2017
Treatment Plan Information
Reference Information (1)
BMT (Allogeneic): Demirer T, et al. Int J Radiat Oncol Biol Phys 1992;32(4):1103-9.
Reference Information (2)
BMT (Allogeneic): Gupta T, et al. Hematol Oncol Stem Cell Ther 2011;4(1):17-29.
Reference Information (3)
BMT (Allogeneic): Socie G, et al. Blood 2001;98(13):3569-74.
Treatment Plan Summary
DISEASE: AML, ALL, CML, MDS, Intermediate or High Grade Non-Hodgkin Lymphoma with chemosensitive disease after
first or greater relapse, Intermediate or High Grade Non-Hodgkin Lymphoma with chemosensitive disease to first line
chemo who have not achieved CR,  relapsed refractory Low Grade Lymphoma and Mantle Cell Lymphoma; THERAPY:
cyclophosphamide 60 mg/kg IV daily Day -7 and Day -6, mesna 60 mg/kg IV on Day -7 and Day -6 prior to
cyclophosphamide, Total Body Irradiation 12 Gy in 8 fractions twice daily Day -4, -3, -2, -1, methotrexate 15 mg/m2 IV
on Day +1, methotrexate 10 mg/m2 IV on Day +3, +6, +11 (Graft vs Host Disease prophylaxis); CYCLE LENGTH: 8 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.
Additional Labs
METHOTREXATE
ONCE Starting S+14 at 0000
METHOTREXATE
ONCE Starting S+19 at 0000
Treatment Conditions
Verify Appointments
Verify Day -4 through Day -1 radiology appointment(s) have been scheduled for Total Body Irradiation 12 Gy in 8 (1.5
Gy) fractions twice daily for a total of 8 doses. Actual start time to be determined on admission.
Nursing Procedure, Assessment and Monitoring
Measure Intake And Output
EVERY 4 HOURS Starting when released Until Specified
Day -7: If urine output less than 400 mL over 4 hours, notify BMT team
Hydration
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
at 100 mL/hr, Intravenous, CONTINUOUS, For 24 hours Starting when released
Day -7.
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Zztestonc,Edward E [2435061]
7/6/2017 3:32:38 PM Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 07/2017CCKM@uwhealth.org

dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
Intravenous, CONTINUOUS, For 24 hours Starting S+1 at 0000
Day -6. 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
Starting Day -5.
Pre-Medications
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, EVERY 24 HOURS, 3 doses Starting when released
Day -7 through Day -5: Administer prior to chemotherapy.
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 -7 through Day -5: Administer prior to chemotherapy.
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
150 mg, Intravenous, ONCE, 1 dose Starting when released
Day -7: administer prior to chemotherapy. Do not infuse with CA++, Mg++, Lactated Ringer's solutions
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, EVERY 24 HOURS, 2 doses Starting when released
Day -7 and Day -6. Administer prior to chemotherapy.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, EVERY 24 HOURS PRN, For 48 hours Starting when released, nausea/vomiting, if unable to tolerate
PO
Day -7 and Day -6. Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, 2 X DAILY (AT MEALTIME), 8 doses Starting S+3 As Scheduled
Day -4 through Day -1. Administer 30 minutes prior to radiation treatments.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, 2 X DAILY PRN, For 96 hours Starting S+3 at 0000, nausea/vomiting, If unable to tolerate PO
Day -4 through Day -1: Administer 30 minutes prior to radiation treatments.
ondansetron (ZOFRAN) tab 12 mg
12 mg, Oral, 2 X DAILY (AT MEALTIME), 8 doses Starting S+3 As Scheduled
Day -4 through Day -1. Administer 30 minutes prior to radiation treatments.
ondansetron (ZOFRAN) 12 mg in sodium chloride 0.9 % 50 mL bag
12 mg, Intravenous, 2 X DAILY PRN, For 96 hours Starting S+3 at 0000, nausea/vomiting, if unable to tolerate PO
Day -4 through Day -1: Administer 30 minutes prior to radiation treatments.
Treatment Medications
mesna (MESNEX) 4,608 mg in sodium chloride 0.9 % 1,000 mL bag
4,608 mg (60 mg/kg × 76.8 kg Treatment plan ideal weight), Intravenous, EVERY 24 HOURS, 2 doses Starting when
released
Day -7 and Day -6. Administer over 24 hours. (Total dose = 120 mg/kg over 48 hours).
cyclophosphamide (CYTOXAN) 4,608 mg bag
4,608 mg (60 mg/kg × 76.8 kg Treatment plan ideal weight), Intravenous, EVERY 24 HOURS, 2 doses Starting when
released
Day -7 and Day -6.
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, 2 X DAILY (AT MEALTIME), 4 doses Starting when released
Day -7 and Day -6: Administer at 1 hour and 6 hours after the start of each dose of cyclophosphamide. IV push rate 10
mg/minute.
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Zztestonc,Edward E [2435061]
7/6/2017 3:32:38 PM Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org

tacrolimus cap
Oral, EVERY 12 HOURS Starting S+4 at 0000
Day -3: Dose = 0.12 mg/kg/day in two divided doses based on Actual body weight. May switch to IV
tacrolimus if patient unable to tolerate PO.
methotrexate PF (TREXALL) injection 30 mg
30 mg (15 mg/m2 × 2 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting S+8 at 0000
Day +1: Administer 24 hours after the completion of stem cell infusion. IV push rate 10 mg/minute.
methotrexate PF (TREXALL) injection 20 mg
20 mg (10 mg/m2 × 2 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting S+10 at 0000
Day +3: IV push rate 10 mg/minute. Check with BMT team before administering dose.
methotrexate PF (TREXALL) injection 20 mg
20 mg (10 mg/m2 × 2 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting S+13 at 0000
Day +6: IV push rate 10 mg/minute. Check with BMT team before administering dose.
methotrexate PF (TREXALL) injection 20 mg
20 mg (10 mg/m2 × 2 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting S+18 at 0000
Day +11: IV push rate 10 mg/minute. Check with BMT team before administering dose.
Conditional Orders
diphenhydramine (BENADRYL) cap RANGE 25-50 mg
25-50 mg, Oral, EVERY 6 HOURS PRN, For 48 hours Starting when released, For nasal burning during cyclophosphamide
administration.
Day -7 and Day -6
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, EVERY 6 HOURS PRN, For 48 hours Starting when released, If unable to tolerate PO. For nasal
burning during cyclophosphamide administration., Administer over 1 Minutes
Day -7 through Day -6
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Zztestonc,Edward E [2435061]
7/6/2017 3:32:38 PM Page 3 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
07/2017CCKM@uwhealth.org