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CSC BMT R-BEAM High Dose Carmustine/Cytarabine/Etoposide/Melphalan/Rituximab VER 11-17-17 (HL 4667)

CSC BMT R-BEAM High Dose Carmustine/Cytarabine/Etoposide/Melphalan/Rituximab VER 11-17-17 (HL 4667) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT R-BEAM HIGH DOSE CARMUSTINE/CYTARABINE/ETOPOSIDE/MELPHALAN/RITUXIMAB VER: 11-17-
17 –  Properties
Conditioning Regimen prior to BMT –  11/16/2017 through 11/28/2017 (13 days), Planned
Outpatient Treatment Orders starting Day -7, Conditioning Regimen prior to BMT –  Planned for
11/16/2017
Treatment Plan Information
Reference Information (1)
BMT (Autologous): Schmitz N, et al. Lancet 2002;238:1002-6.
Treatment Plan Summary
DISEASE: Non-Hodgkin's Lymphoma
THERAPY: rituximab 375 mg/m2 IV Day -7, carmustine 300 mg/m2 IV Day -6, etoposide 200 mg/m2 IV every 12 hours
Day -5, -4, -3, -2 (Total of 8 doses), cytarabine 200 mg/m2 IV every 12 hours Day -5, -4, -3, -2 (Total of 8 doses),
melphalan 140 mg/m2 IV Day -1;
CYCLE LENGTH: 13 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.
Note to All Staff (1)
Reactivation of hepatitis B virus (HBV) may occur and in some cases result in fulminant hepatitis, hepatic failure, or
death. Screen patients for HBV infection prior to rituximab treatment and consider prophylaxis against reactivation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
HEPATITIS B CORE AB, TOTAL
Expected: S Approximate, Expires: S+365, Routine
HEPATITIS B SURFACE AG
Expected: S Approximate, Expires: S+365, Routine
HEPATITIS B SURFACE AB
Expected: S Approximate, Expires: S+122, Routine
Pre-Labs (delete all that do not apply)
HEPATITIS B DNA, ULTRA QUANT, PCR
Expected: S Approximate, Expires: S+122, Routine
Draw if Hepatitis B Core AB is positive.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to rituximab can occur and is most common with the first or second dose or if greater than 6
months since last dose. For first and second dose patient should be treated in a location to optimize emergency care.
See Emergency Meds.
Monitoring Parameters (1)
Educate patients regarding the potential of occurence for severe mucocutaneous reactions with rituximab.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes until rituximab infusion
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Zztestonc,Jeff J [2507481]
11/16/2017 12:06:50 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

complete. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain, or hypotension,
stop infusion and contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during
which the reaction occurred.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Day -7: Administer prior to rituximab.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Day -7: Administer prior to rituximab.
Emergency Medications
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 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 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
rituximab (RITUXAN) 700 mg in sodium chloride 0.9 % 500 mL bag
700 mg (rounded from 735 mg = 375 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous,
ONCE, 1 dose Starting when released
Day -7. Hypersensitivity Risk. See Emergency Medications. Administer rituximab prior to any chemotherapy. See Note
on MAR for infusion rates. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain
or hypotension, contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during
which the reaction occurred.
Follow-Up
DAY 2 FOLLOW-UP
Verify preadmission to B6/6 for Bone Marrow Transplantation
Inpatient Treatment Orders starting Day -6, Conditioning Regimen prior to BMT –  Planned for
11/17/2017
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Zztestonc,Jeff J [2507481]
11/16/2017 12:06:50 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