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20170383

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UWHC,UWMF,

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

CSC HEM Venetoclax Low Med Tumor Burden VER 3-9-17 (HL 6145)

CSC HEM Venetoclax Low Med Tumor Burden VER 3-9-17 (HL 6145) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Lymphoma


CSC HEM VENETOCLAX LOW/MED 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) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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) Low/Med 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 trial of at least one prior
therapy.
Note to All Staff (2)
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 1 of 16
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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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 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: Uric Acid, Potassium, Phosphate, Calcium and Creatinine.
Treatment Parameters
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 2 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

Hold and notify authorizing prescriber for: Uric Acid greater than or equal to 8 mg/dL or Potassium greater than or equal to 6 mmol/L
or Phosphate greater than or equal to 4.5 mg/dL or Calcium less than or equal to 7 mg/dL 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 (delete all that do not apply)
sodium chloride 0.9% BOLUS
1,000 mL, Intravenous, ONCE, 1 dose Starting when released
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).
Follow-Up
DAY 2 FOLLOW-UP
LABS: Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 8 FOLLOW-UP
LABS: CBC with DIFF, Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 9 FOLLOW-UP
LABS: Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 16 FOLLOW-UP
LABS: CBC with DIFF, Potassium, Uric Acid, Phosphate, Calcium and Creatinine.
DAY 23 FOLLOW-UP
LABS: CBC with DIFF, 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 1 – Planned for 3/23/2017
Treatment Plan Information
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 3 of 16
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) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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.
Day 8, Cycle 1 – Planned for 3/29/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 4 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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: 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 Potassium greater than or equal to 6 mmol/L
or Phosphate greater than or equal to 4.5 mg/dL or Calcium less than or equal to 7 mg/dL 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.
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 5 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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 (delete all that do not apply)
sodium chloride 0.9% BOLUS
1,000 mL, Intravenous, ONCE, 1 dose Starting when released
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).
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day 9 - Lab Only, Cycle 1 – Planned for 3/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 6 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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.
Day 16 - Lab Only, Cycle 1 – Planned for 4/6/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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+8 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+8 Approximate, Expires-S+365, Routine
URIC ACID
Expected-S+8 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+8 Approximate, Expires-S+365, Normal, Routine
CALCIUM
Expected-S+8 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+8 Approximate, Expires-S+365, Routine
Follow-Up
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 7 of 16
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) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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+15 Approximate, Expires-S+365, Routine
POTASSIUM
Expected-S+15 Approximate, Expires-S+365, Routine
URIC ACID
Expected-S+15 Approximate, Expires-S+365, Routine
PHOSPHATE
Expected-S+15 Approximate, Expires-S+365, Normal, Routine
CALCIUM
Expected-S+15 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+15 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) Low/Med 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.
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 8 of 16
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 (1)
This regimen is Chemotherapy Council approved for use in patients with CLL with 17p deletion after trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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+21 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
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
ONCE Starting when released
Obtain Blood Pressure, Heart Rate, Respiratory Rate and Temperature
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 (delete all that do not apply)
sodium chloride 0.9% BOLUS
1,000 mL, Intravenous, ONCE, 1 dose Starting when released
Treatment Medications
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 9 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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: CBC with DIFF, 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
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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+1 Approximate, Expires-S+365, Routine
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
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 10 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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.
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 11 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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
Treatment Plan Information
Treatment Plan Summary
DISEASE: Chronic Lymphocytic Leukemia (Relapsed/Refractory) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 12 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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 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) Low/Med 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 trial of at least one prior
therapy.
Note to All Staff (2)
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 13 of 16
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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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
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 8:56:25 AM Page 14 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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) Low/Med 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 trial of 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)
Low tumor burden defined as any lymph node less than 5 cm AND Absolute Lymphocyte Count less than 25K/uL. Medium tumor
burden defined as any lymph node 5 cm to less than 10 cm OR Absolute Lymphocyte Count greater than or equal to 25K/uL.
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
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Zztestonc,Edward E [2435061]
3/22/2017 8:56:25 AM Page 15 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org

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 8:56:25 AM Page 16 of 16
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
03/2017CCKM@uwhealth.org