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CSC BMT BEAM High Dose Carmustine/Cytarabine/Etoposide/Melphalan VER 11-17-17 (HL 4663)

CSC BMT BEAM High Dose Carmustine/Cytarabine/Etoposide/Melphalan VER 11-17-17 (HL 4663) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT BEAM HIGH DOSE CARMUSTINE/CYTARABINE/ETOPOSIDE/MELPHALAN VER: 11-17-17 –  Properties
Conditioning Regimen prior to BMT –  11/16/2017 through 11/27/2017 (12 days), Planned
Treatment Orders starting Day -6, 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: Hodgkin or Non-Hodgkin Lymphoma
THERAPY: 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: 12 days;
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 prescriber prior to releasing treatment medications and
document in a progress note.
Nursing Procedure, Assessment and Monitoring
Vital Signs
EVERY 1 HOUR Starting when released Until Specified
On Day -5 through Day -2 during etoposide infusion, check BP and HR every hour. If BP falls below 100 mmHg systolic
or if baseline BP less than 100 mmHg systolic but then decreases by 10%, stop infusion and start Sodium Chloride 0.9%
at 250 mL/h and notify BMT Team.
Patient Instructions(1)
RN instruct patient on cryotherapy to reduce incidence and severity of oral mucositis. Offer cryotherapy 10 minutes
before, during, and for a total of 60 minutes after melphalan administration. See Health Fact for You #7502 "Controlling
Mouth Sores from Melphalan".
Hydration
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
Intravenous, CONTINUOUS, For 24 hours Starting when released
Rate = 2 L/m2/24h for first 24 hours (s to s+1)
dextrose 5%-NaCl 0.45% with KCl 20 mEq/L infusion
at 75 mL/hr, Intravenous, CONTINUOUS Starting S+1 at 0000 Until Discontinued
Start 24 hour after pre-hydration and continue throughout treatment.
Pre-Medications
lorazepam (ATIVAN) tab 1 mg
1 mg, Oral, ONCE, 1 dose Starting when released
Day -6: Administer 15 minutes prior to carmustine.
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
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Zztestonc,Jeff J [2507481]
11/16/2017 12:04:59 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

150 mg, Intravenous, ONCE, 1 dose Starting when released
Day-6: administer prior to carmustine. Do not infuse with CA++, Mg++, Lactated Ringer's solutions
ondansetron (ZOFRAN) tab 12 mg
12 mg, Oral, EVERY 12 HOURS, 12 doses Starting when released
Day -6 through Day -1: Administer prior to chemotherapy.
ondansetron (ZOFRAN) 12 mg in sodium chloride 0.9 % 50 mL bag
12 mg, Intravenous, EVERY 12 HOURS PRN, 12 doses Starting when released, nausea/vomiting, if unable to tolerate PO
Day -6 through Day -1: Administer prior to chemotherapy for 30 minutes.
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, EVERY 24 HOURS, 6 doses Starting when released
Day -6 through Day -1: Administer prior to chemotherapy.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, 6 doses Starting when released, nausea/vomiting, if unable to tolerate PO
Day -6 through Day -1: Administer prior to chemotherapy.
Treatment Medications
carmustine (BiCNU) 555 mg in sodium chloride 0.9 % 500 mL non-PVC bag
555 mg (300 mg/m2 × 1.85 m2 Treatment plan adjusted BSA), Intravenous, ONCE, 1 dose Starting when released
Day -6. Administer over 2 hours with Non-PVC tubing
etoposide (VEPESID) 392 mg in sodium chloride 0.9 % 1,000 mL NSS bag
392 mg (200 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, EVERY 12 HOURS, 8 doses
Starting S+1 at 0000
Day -5 through Day -2. Administer over 2 hours. Administer with non-PVC tubing.
If dose is less than 300 mg, dilute in 500 mL NS. If dose is greater than or equal to 300 mg, dilute in 1000 mL NS.
cytarabine PF (CYTOSAR) 392 mg in sodium chloride 0.9 % 250 mL bag
392 mg (200 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, EVERY 12 HOURS, 8 doses
Starting S+1 at 0000
Day -5 through Day -2.
melphalan (ALKERAN) injection 274.5 mg
274.5 mg (rounded from 274.4 mg = 140 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous,
ONCE, 1 dose Starting S+5 at 0000, Administer over 15 Minutes
Day -1: Administer over 15 minutes. Pharmacist and RN must coordinate timing of administration to allow
administration of dose as close as possible to time of dose preparation due to poor stability and short expiration of
drug. Drug must be given within 60 minutes of reconstitution.
Conditional Orders
sodium chloride 0.9 % infusion
at 250 mL/hr, Intravenous, PRN Starting when released Until Discontinued, hypotension
Administer if BP falls below treatment parameters during etoposide infusion
Supportive Care Medications
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Subcutaneous, 1 X DAILY (PM) Starting S+11 As Scheduled
Start on Day +5. Discontinue when ANC is greater than 500/µL for 2 consecutive days.
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Zztestonc,Jeff J [2507481]
11/16/2017 12:04:59 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