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CSC BMT Busulfan-Cyclophosphamide VER 4-11-17 (HL 4453)

CSC BMT Busulfan-Cyclophosphamide VER 4-11-17 (HL 4453) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT BUSULFAN-CYCLOPHOSPHAMIDE VER: 4-11-17 – Properties
Treatment Orders for Day -8 to Day 11 – 4/11/2017 through 4/30/2017 (20 days), Planned
Day 1, Treatment Orders for Day -8 to Day 11 – Planned for 4/11/2017
Treatment Plan Information
Reference Information (1)
BMT (Autologous or Allogeneic): Clift RA, et al. Blood 1994;84:2036-43.
Treatment Plan Summary
DISEASE: AML, ALL, CML, MDS, refractory Multiple Myeloma, relapsed chemo-sensitive Intermediate Grade and Mantle Cell
Lymphoma, relapsed, refractory Follicular Lymphoma or CLL, relapsed refractory Hodgkin Disease, High Grade NHL; THERAPY:
busulfan 0.8 mg/kg every 6 hours IV Day -7, -6, -5, -4 (Total of 16 doses), mesna 60 mg/kg IV on Day -3 and Day -2,
cyclophosphamide 60 mg/kg/day IV on Day -3 and Day -2, 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.
Consent
Verify Consent
Verify informed consent has been obtained.
Additional Labs
METHOTREXATE
ONCE Starting S+15 at 0000
METHOTREXATE
ONCE Starting S+20 at 0000
Nursing Procedure, Assessment and Monitoring
Measure Intake And Output
EVERY 4 HOURS Starting S+5 at 0000 Until Specified
Once cyclophosphamide administration begins monitor urine output to assure minimum of 400 mL over 4 hours. If urine output less
than 400 mL over 4 hours, notify BMT team.
Pharmacokinetic Sampling
Pharmacokinetic Sample
Obtain busulfan level after the first dose. BMT coordinator to make necessary arrangements.
Hydration
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
at 150 mL/hr, Intravenous, CONTINUOUS, For 4 days Starting when released until S+3 at 2359
Day -8 through Day -4.
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
Intravenous, CONTINUOUS, For 4 days Starting S+5 at 0000 until S+8 at 2359
Day -3 through Day 0. Rate = 3 L/m2/24 h.
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting S+8 at 0000 Until Discontinued
Day 0: Start after stem cell infusion.
Pre-Medications
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, EVERY 24 HOURS, 7 doses Starting S+1 at 0000
Day -7 through Day -1.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 168 hours Starting S+1 at 0000, nausea/vomiting, if unable to tolerate PO
dexamethasone
Day -7 through Day -1.
ondansetron (ZOFRAN) tab 12 mg
12 mg, Oral, EVERY 12 HOURS, 8 doses Starting S+1 at 0000
Day -7 through Day -4.
ondansetron (ZOFRAN) 12 mg in sodium chloride 0.9 % 50 mL bag
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ZZtestonc,Andrew [2428787]
4/11/2017 3:24:04 PM Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org

12 mg, Intravenous, EVERY 12 HOURS PRN, For 96 hours Starting S+1 at 0000, nausea/vomiting, if unable to
tolerate PO
Day -7 through Day -4.
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
150 mg, Intravenous, ONCE, 1 dose Starting S+5 at 0000
Day -3: 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 S+5 at 0000
Day -3 and Day -2 prior to cyclophosphamide.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, EVERY 24 HOURS PRN, For 48 hours Starting S+5 at 0000, nausea/vomiting, inf unable to tolerate PO
Day -3 and Day -2 prior to cyclophosphamide.
Treatment Medications
busulfan (BUSULFEX) 0.8 mg/kg in sodium chloride 0.9 % 100 mL bag
0.8 mg/kg, Intravenous, EVERY 6 HOURS, 16 doses Starting S+1 at 0000
Day -7 through Day -4: Start at 0600 on Day -7. Doses on Day -6, -5 and -4 may change depending on pharmacokinetic
calculations. Obtain pharmacokinetics with first dose.
mesna (MESNEX) 60 mg/kg in dextrose 5 % 1,000 mL bag
60 mg/kg, Intravenous, EVERY 24 HOURS, 2 doses Starting S+5 at 0000
Day -3 and Day -2. Administer as continuous infusion.
cyclophosphamide (CYTOXAN) 60 mg/kg bag
60 mg/kg, Intravenous, EVERY 24 HOURS, 2 doses Starting S+5 at 0000
Day -3 and Day -2.
tacrolimus cap
Oral, EVERY 12 HOURS Starting S+5 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.
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, EVERY 5 HOURS, 2 doses Starting when released
Day -3: Administer at 1 hour and 6 hours after the start of each cyclophosphamide dose to promote diuresis. IV push rate 10
mg/minute.
furosemide (LASIX) 10 MG/ML injection 20 mg
20 mg, Intravenous, EVERY 5 HOURS, 2 doses Starting S+6 at 0000
Day -2: Administer at 1 hour and 6 hours after the start of each cyclophosphamide dose to promote diuresis. IV push rate 10
mg/minute.
methotrexate PF (TREXALL) injection 15 mg/m2 (Treatment Plan)
15 mg/m2, Intravenous, ONCE, 1 dose Starting S+9 at 0000
Day +1: Administer 24 hours after the completion of stem cell infusion. IV push rate 10 mg/minute.
methotrexate PF (TREXALL) injection 10 mg/m2 (Treatment Plan)
10 mg/m2, Intravenous, ONCE, 1 dose Starting S+11 at 0000
Day +3: Check with BMT Team before administering dose. IV push rate 10 mg/minute.
methotrexate PF (TREXALL) injection 10 mg/m2 (Treatment Plan)
10 mg/m2, Intravenous, ONCE, 1 dose Starting S+14 at 0000
Day +6: Check with BMT Team before administering dose. IV push rate 10 mg/minute.
methotrexate PF (TREXALL) injection 10 mg/m2 (Treatment Plan)
10 mg/m2, Intravenous, ONCE, 1 dose Starting S+19 at 0000
Day +11: Check with BMT Team before administering dose. IV push rate 10 mg/minute.
Conditional Orders
diphenhydramine (BENADRYL) cap RANGE 25-50 mg
25-50 mg, Oral, PRN, For 48 hours Starting S+5 at 0000, For nasal burning during cyclophosphamide administration.
Day -3 and Day -2.
diphenhydramine (BENADRYL) injection RANGE 25-50 mg
25-50 mg, Intravenous, PRN, For 48 hours Starting S+5 at 0000, If unable to tolerate PO. For nasal burning during
cyclophosphamide administration. , Administer over 1 Minutes
Day -3 and Day -2.
Supportive Care Medications
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ZZtestonc,Andrew [2428787]
4/11/2017 3:24:04 PM Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org

levetiracetam (KEPPRA) tab 500 mg
500 mg, Oral, 2 X DAILY, 14 doses Starting at treatment start time
Day -8 to Day -2
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ZZtestonc,Andrew [2428787]
4/11/2017 3:24:04 PM Page 3 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
04/2017CCKM@uwhealth.org