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20170383

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Hem - Lymphoma

CSC HEM INPT OUTPT Venetoclax High Tumor Burden VER 3-9-17 (HL 6153)

CSC HEM INPT OUTPT Venetoclax High Tumor Burden VER 3-9-17 (HL 6153) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Lymphoma


CSC HEM INPT/OUTPT VENETOCLAX HIGH TUMOR BURDEN VER: 3-9-17 – Properties
Pre-Cycle – 3/15/2017 through 3/21/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 3/15/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
Consent
Verify Consent
Verify informed consent has been obtained.
Take Home Medications
venetoclax (VENCLEXTA) 10 & 50 & 100 MG TBPK
Take by mouth once daily as directed with a meal. Swallow whole. Weeks 1 through 4., Disp-1 each, R-0, starting S, Local Printer
allopurinol (ZYLOPRIM) 300 MG tab
Take 1 tab by mouth one time daily. Start 2 to 3 days before initiation of venetoclax. Take during Cycle 1 only., 300 mg, Disp-30 tab,
R-1, 1 X DAILY starting S, Local Printer
acyclovir (ZOVIRAX) 400 MG tab
Take 1 tab by mouth 2 times daily., 400 mg, Disp-60 tab, R-5, 2 X DAILY starting S, Local Printer
Take Home Medications (delete all that do not apply)
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab
Take 1 tablet by mouth once daily on Monday, Wednesday and Friday., Disp-12 tab, R-5, starting S, Local Printer
Cycle 1 – 3/22/2017 through 4/18/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 3/22/2017
Treatment Plan Information
Reference Information (1)
CHRONIC LYMPHOCYTIC LEUKEMIA: Roberts AW, et al. N Engl J Med 2016;374(4):311-22.
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 1 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 03/2017CCKM@uwhealth.org

Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count
greater than or equal to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released
Predose
POTASSIUM
ONCE Starting when released
Predose
POTASSIUM
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
POTASSIUM
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
URIC ACID
ONCE Starting when released
Predose
URIC ACID
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
URIC ACID
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
PHOSPHATE
ONCE Starting when released
Predose
PHOSPHATE
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
PHOSPHATE
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
CALCIUM
ONCE Starting when released
Predose
CALCIUM
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
CALCIUM
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
CREATININE
ONCE Starting when released
Predose
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 2 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

CREATININE
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
CREATININE
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Uric Acid, Potassium, Phosphate, Calcium and Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for: Uric Acid greater than or equal to 8 mg/dL (or 25% increase from baseline) or Potassium
greater than or equal to 6 mmol/L (or 25% increase from baseline) or Phosphate greater than or equal to 4.5 mg/dL (or 25%
increase from baseline) or Calcium less than or equal to 7 mg/dL (or 25% decrease from baseline) or Creatinine Clearance less than
80 mL/min.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor and educate patients for signs and symptoms associated with tumor lysis syndrome (fever, chills, nausea, vomiting,
confusion, shortness of breath, seizure, irregular heartbeat, dark or cloudy urine, unusual tiredness, muscle pain, and/or joint
discomfort). Contact physician if toxicity is suspected.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain Blood Pressure, Heart Rate, Respiratory Rate and Temperature predose, and at 4, 8, 12 and 24 hours post venetoclax dose.
Patient Instructions(1)
Instruct patient to drink 6 to 8 (8 ounce) glasses of water daily during treatment.
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 150 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Treatment Medications
venetoclax (VENCLEXTA) tab 20 mg
20 mg, Oral, EVERY 24 HOURS, 7 doses Starting when released
Day 1 through Day 7. Administer with a meal and water. Swallow whole; do not crush, chew, or break. Patients own supply.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (starter pack is dispensed Day 1 of
Pre-Cycle).
Supportive Care Medications
allopurinol (ZYLOPRIM) tab 300 mg
300 mg, Oral, 1 X DAILY Starting when released
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 3 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

1 tab, Oral, EVERY MON, WED, FRI Starting when released
Follow-Up
DAY 8 FOLLOW-UP
Verify Admission to B6/6. LABS: CBC with DIFF, Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 15 FOLLOW-UP
LABS: CBC with DIFF, Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 16 FOLLOW-UP
LABS: Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 22 FOLLOW-UP
LABS: CBC with DIFF, Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 23 FOLLOW-UP
LABS: Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Potassium, Uric Acid, Phosphate,
Calcium and Creatinine.
Day 8, Cycle 1 – Planned for 3/29/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released
Predose
POTASSIUM
ONCE Starting when released
Predose
POTASSIUM
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
POTASSIUM
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
URIC ACID
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 4 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

ONCE Starting when released
Predose
URIC ACID
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
URIC ACID
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
PHOSPHATE
ONCE Starting when released
Predose
PHOSPHATE
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
PHOSPHATE
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
CALCIUM
ONCE Starting when released
Predose
CALCIUM
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
CALCIUM
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
CREATININE
ONCE Starting when released
Predose
CREATININE
EVERY 4 HOURS Starting when released for 3 occurrences
Draw at 4, 8 and 12 hours post venetoclax dose.
CREATININE
ONCE Starting S+1 at 0000
Draw at 24 hours post venetoclax dose.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC, Uric Acid, Potassium, Phosphate, Calcium and Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for: ANC less than 1000/uL or Uric Acid greater than or equal to 8 mg/dL (or 25% increase
from baseline) or Potassium greater than or equal to 6 mmol/L (or 25% increase from baseline) or Phosphate greater than or equal
to 4.5 mg/dL (or 25% increase from baseline) or Calcium less than or equal to 7 mg/dL (or 25% decrease from baseline) or
Creatinine Clearance less than 80 mL/min.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor and educate patients for signs and symptoms associated with tumor lysis syndrome (fever, chills, nausea, vomiting,
confusion, shortness of breath, seizure, irregular heartbeat, dark or cloudy urine, unusual tiredness, muscle pain, and/or joint
discomfort). Contact physician if toxicity is suspected.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain Blood Pressure, Heart Rate, Respiratory Rate and Temperature predose, and at 4, 8, 12 and 24 hours post venetoclax dose.
Patient Instructions(1)
Instruct patient to drink 6 to 8 (8 ounce) glasses of water daily during treatment.
Flush Venous Access Device per Guidelines
Order details
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 5 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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 150 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Treatment Medications
venetoclax (VENCLEXTA) tab 50 mg
50 mg, Oral, EVERY 24 HOURS, 7 doses Starting when released
Day 8 through Day 14. Administer with a meal and water. Swallow whole; do not crush, chew, or break. Patient's own supply.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (starter pack is dispensed Day 1 of
Pre-Cycle).
Supportive Care Medications
allopurinol (ZYLOPRIM) tab 300 mg
300 mg, Oral, 1 X DAILY Starting when released
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
1 tab, Oral, EVERY MON, WED, FRI Starting when released
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 15, Cycle 1 – Planned for 4/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 6 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S Approximate, Expires-S+122, Normal, Routine
Predose
POTASSIUM
Expected-S Approximate, Expires-S+397, Normal, Routine
Predose
POTASSIUM
Expected-S Approximate, Expires-S+397, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
URIC ACID
Expected-S Approximate, Expires-S+122, Normal, Routine
Predose
URIC ACID
Expected-S Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
PHOSPHATE
Expected-S Approximate, Expires-S+122, Normal, Routine
Predose
PHOSPHATE
Expected-S Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
CALCIUM
Expected-S Approximate, Expires-S+122, Normal, Routine
Predose
CALCIUM
Expected-S Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
CREATININE
Expected-S Approximate, Expires-S+397, Normal, Routine
Predose
CREATININE
Expected-S Approximate, Expires-S+397, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC, Uric Acid, Potassium, Phosphate, Calcium and Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for: ANC less than 1000/uL or Uric Acid greater than or equal to 8 mg/dL (or 25% increase
from baseline) or Potassium greater than or equal to 6 mmol/L (or 25% increase from baseline) or Phosphate greater than or equal
to 4.5 mg/dL (or 25% increase from baseline) or Calcium less than or equal to 7 mg/dL (or 25% decrease from baseline) or
Creatinine Clearance less than 80 mL/min.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor and educate patients for signs and symptoms associated with tumor lysis syndrome (fever, chills, nausea, vomiting,
confusion, shortness of breath, seizure, irregular heartbeat, dark or cloudy urine, unusual tiredness, muscle pain, and/or joint
discomfort). Contact physician if toxicity is suspected.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain Blood Pressure, Heart Rate, Respiratory Rate and Temperature predose and at 6 to 8 hours post venetoclax dose.
Patient Instructions(1)
Instruct patient to drink 6 to 8 (8 ounce) glasses of water daily during treatment.
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 7 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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% BOLUS
1,000 mL, Intravenous, ONCE PRN Starting when released Until Discontinued, hydration
Treatment Medications
venetoclax (VENCLEXTA) tab 100 mg
100 mg, Oral, EVERY 24 HOURS, 7 doses Starting when released
Day 15 through Day 21. Administer with a meal and water. Swallow whole; do not crush, chew, or break. Patient own supply.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (starter pack is dispensed Day 1 of
Pre-Cycle).
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 16 - Lab Only, Cycle 1 – Planned for 4/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
POTASSIUM
Expected-S+1 Approximate, Expires-S+365, Routine
URIC ACID
Expected-S+1 Approximate, Expires-S+365, Routine
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 8 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

PHOSPHATE
Expected-S+1 Approximate, Expires-S+365, Normal, Routine
CALCIUM
Expected-S+1 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+1 Approximate, Expires-S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 22, Cycle 1 – Planned for 4/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
POTASSIUM
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Predose
POTASSIUM
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
URIC ACID
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
URIC ACID
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
PHOSPHATE
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
PHOSPHATE
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 9 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

CALCIUM
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
CALCIUM
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
CREATININE
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Predose
CREATININE
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC, Uric Acid, Potassium, Phosphate, Calcium and Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for: ANC less than 1000/uL or Uric Acid greater than or equal to 8 mg/dL (or 25% increase
from baseline) or Potassium greater than or equal to 6 mmol/L (or 25% increase from baseline) or Phosphate greater than or equal
to 4.5 mg/dL (or 25% increase from baseline) or Calcium less than or equal to 7 mg/dL (or 25% decrease from baseline) or
Creatinine Clearance less than 80 mL/min.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor and educate patients for signs and symptoms associated with tumor lysis syndrome (fever, chills, nausea, vomiting,
confusion, shortness of breath, seizure, irregular heartbeat, dark or cloudy urine, unusual tiredness, muscle pain, and/or joint
discomfort). Contact physician if toxicity is suspected.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain Blood Pressure, Heart Rate, Respiratory Rate and Temperature predose and at 6 to 8 hours post venetoclax dose.
Patient Instructions(1)
Instruct patient to drink 6 to 8 (8 ounce) glasses of water daily during treatment.
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% BOLUS
1,000 mL, Intravenous, ONCE PRN Starting when released Until Discontinued, hydration
Treatment Medications
venetoclax (VENCLEXTA) tab 200 mg
200 mg, Oral, EVERY 24 HOURS, 7 doses Starting when released
Day 22 through Day 28. Administer with a meal and water. Swallow whole; do not crush, chew, or break. Patient own supply.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (starter pack is dispensed Day 1 of
Pre-Cycle).
Follow-Up
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 10 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 23 - Lab Only, Cycle 1 – Planned for 4/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
POTASSIUM
Expected-S+1 Approximate, Expires-S+365, Routine
URIC ACID
Expected-S+1 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+1 Approximate, Expires-S+365, Normal, Routine
CALCIUM
Expected-S+1 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+1 Approximate, Expires-S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 – 4/19/2017 through 5/16/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 4/19/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 11 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider
intermittent growth factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
POTASSIUM
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Predose
POTASSIUM
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
URIC ACID
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
URIC ACID
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
PHOSPHATE
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
PHOSPHATE
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
CALCIUM
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Predose
CALCIUM
Expected-S+7 Approximate, Expires-S+122, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
CREATININE
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Predose
CREATININE
Expected-S+7 Approximate, Expires-S+397, Normal, Routine
Draw 6 to 8 hours post venetoclax dose.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC, Uric Acid, Potassium, Phosphate, Calcium and Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for: ANC less than 1000/uL or Uric Acid greater than or equal to 8 mg/dL (or 25% increase
from baseline) or Potassium greater than or equal to 6 mmol/L (or 25% increase from baseline) or Phosphate greater than or equal
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 12 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

to 4.5 mg/dL (or 25% increase from baseline) or Calcium less than or equal to 7 mg/dL (or 25% decrease from baseline) or
Creatinine Clearance less than 80 mL/min.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor and educate patients for signs and symptoms associated with tumor lysis syndrome (fever, chills, nausea, vomiting,
confusion, shortness of breath, seizure, irregular heartbeat, dark or cloudy urine, unusual tiredness, muscle pain, and/or joint
discomfort). Contact physician if toxicity is suspected.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain Blood Pressure, Heart Rate, Respiratory Rate and Temperature predose and at 6 to 8 hours post venetoclax dose.
Patient Instructions(1)
Instruct patient to drink 6 to 8 (8 ounce) glasses of water daily during treatment.
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% BOLUS
1,000 mL, Intravenous, ONCE PRN Starting when released Until Discontinued, hydration
Treatment Medications
venetoclax (VENCLEXTA) tab 400 mg
400 mg, Oral, EVERY 24 HOURS Starting when released
Administer with a meal and water. Swallow whole; do not crush, chew, or break. Patient own supply.
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (dispensed Day 1 of each cycle).
Take Home Medications (delete all that do not apply)
venetoclax (VENCLEXTA) 10 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 50 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take 4 tabs by mouth one time daily., 400 mg, Disp-120 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 2 FOLLOW-UP
LABS: Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF.
Day 2 - Lab Only, Cycle 2 – Planned for 4/20/2017
Treatment Plan Information
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 13 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY:
venetoclax 20 mg by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax
100 mg by mouth daily Day 15 through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE
LENGTH: 28 Days; COURSE: 1 cycle followed by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily
continuously; CYCLE LENGTH: 28 Days; COURSE: until disease progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
POTASSIUM
Expected-S+1 Approximate, Expires-S+365, Routine
URIC ACID
Expected-S+1 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+1 Approximate, Expires-S+365, Normal, Routine
CALCIUM
Expected-S+1 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+1 Approximate, Expires-S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 – 5/17/2017 through 6/13/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 5/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
Consent
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 14 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL.
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.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (dispensed Day 1 of each cycle).
Take Home Medications (delete all that do not apply)
venetoclax (VENCLEXTA) 10 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 50 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take 4 tabs by mouth one time daily., 400 mg, Disp-120 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle). RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF.
Cycle 4 – 6/14/2017 through 7/11/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 6/14/2017
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 15 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL.
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.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (dispensed Day 1 of each cycle).
Take Home Medications (delete all that do not apply)
venetoclax (VENCLEXTA) 10 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 50 MG tab
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 16 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take 4 tabs by mouth one time daily., 400 mg, Disp-120 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle). RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF.
Cycle 5 – 7/12/2017 through 8/8/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 7/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL.
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
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 17 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (dispensed Day 1 of each cycle).
Take Home Medications (delete all that do not apply)
venetoclax (VENCLEXTA) 10 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 50 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take 4 tabs by mouth one time daily., 400 mg, Disp-120 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle). RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF.
Cycle 6 – 8/9/2017 through 9/5/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 8/9/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) High Tumor Burden; INDUCTION THERAPY: venetoclax 20 mg
by mouth daily Day 1 through 7, venetoclax 50 mg by mouth daily Day 8 through 14, venetoclax 100 mg by mouth daily Day 15
through Day 21, venetoclax 200 mg by mouth daily Day 22 through Day 28; CYCLE LENGTH: 28 Days; COURSE: 1 cycle followed
by MAINTENANCE THERAPY: venetoclax 400 mg by mouth daily continuously; CYCLE LENGTH: 28 Days; COURSE: until disease
progression.
Note to All Staff (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after at least one prior therapy.
Note to All Staff (2)
For dose modifications related to toxicity and drug-drug interactions please see link to package insert. Consider intermittent growth
factor use as clinically appropriate for neutropenia.
Note to all Staff (3)
High tumor burden defined as any lymph node greater than or equal to 10 cm OR Absolute Lymphocyte Count greater than or equal
to 25K/uL AND any lymph node greater than or equal to 5 cm.
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.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 18 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than 1,000/µL.
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.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): venetoclax (dispensed Day 1 of each cycle).
Take Home Medications (delete all that do not apply)
venetoclax (VENCLEXTA) 10 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 50 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
venetoclax (VENCLEXTA) 100 MG tab
Take 4 tabs by mouth one time daily., 400 mg, Disp-120 tab, R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle). RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF.
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Zztestonc,Edward E [2435061]
3/22/2017 8:52:43 AM Page 19 of 19
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org