/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/hem---lymphoma/,

/clinical/cckm-tools/content/beacon-protocols/hem---lymphoma/name-96900-en.cckm

201605136

page

100

UWHC,UWMF,

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

CSC Hem Inpt Etop(21D1-4)Pred(21D1-6)Vinc(21D1-4)Doxor(21D1-4)Cycloph(21D5)Ritux(21D1)Ver2-2-16(HL 1776)

CSC Hem Inpt Etop(21D1-4)Pred(21D1-6)Vinc(21D1-4)Doxor(21D1-4)Cycloph(21D5)Ritux(21D1)Ver2-2-16(HL 1776) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Hem - Lymphoma


CSC HEM INPT ETOPOSIDE(21D:1-4)/PREDNISONE(21D:1-6)/VINCRISTINE(21D:1-4)/DOXORUBICIN(21D:1-
4)/CYCLOPHOSPHAMIDE(21D:5)/RITUXIMAB(21D:1) VER: 2-2-16 – Properties
Cycle 1 – 2/4/2016 through 2/24/2016 (21 days), Planned
Day 1 through 6 Inpatient, Cycle 1 – Planned for 2/4/2016 through 2/9/2016
Treatment Plan Information
Reference Information (1)
NON-HODGKIN LYMPHOMA: Gutierrez BA, et al. J Clin Oncol 2000;18(21):3633-42.
Reference Information (2)
NON-HODGKIN LYMPHOMA: Wilson W, et al. J Clin Oncol 1993;11(8):1573-82.
Reference Information (3)
NON-HODGKIN LYMPHOMA: Wolfe JL, et al. AM J Health Syst Pharm1999;56(10):985-9.
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma (Relapsed/ Refractory); THERAPY: rituximab 375 mg/m2 IV Day 1,
prednisone 100 mg by mouth Days 1 through 6, etoposide 50 mg/m2/day IV continuous infusion over 24 hours Day 1
through 4 (infuse over 96 hours: Total dose = 200 mg/m2), vinCRIStine 0.4 mg/m2/day IV continuous infusion over 24
hours Day 1 through 4 (infuse over 96 hours: Total dose = 1.6 mg/m2), doxorubicin 10 mg/m2/day IV continuous
infusion over 24 hours Day 1 through 4 (infuse over 96 hours: Total dose = 40 mg/m2), cyclophosphamide 750 mg/m2
IV Day 5; GROWTH FACTOR REQUIRED; CYCLE LENGTH: 21 to 28 days; COURSE: 4 to 6 cycles
Note to All Staff (1)
This regimen is the non-dose adjusted version of R-EPOCH.
Note to All Staff (2)
Reactivation of hepatitis B virus (HBV) may occur and in some cases result in fulminant hepatitis,
hepatic failure, or death. Screen patients for HBV infection prior to rituximab treatment and consider prophylaxis against
reactivation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released, Routine
CREATININE
ONCE Starting when released, Routine
POTASSIUM
EVERY MONDAY AND THURSDAY Starting S As Scheduled for 2 occurrences
URIC ACID
EVERY MONDAY AND THURSDAY Starting S As Scheduled for 2 occurrences
LD, TOTAL
EVERY MONDAY AND THURSDAY Starting S As Scheduled for 2 occurrences
HEPATITIS B CORE AB, TOTAL
ONCE Starting when released
HEPATITIS B SURFACE AG
ONCE Starting when released
HEPATITIS B SURFACE AB
ONCE Starting when released
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 1 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Pre-Labs (delete all that do not apply)
HEPATITIS B DNA, ULTRA QUANT, PCR
ONCE Starting when released
Draw if Hepatitis B Core AB is positive.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine, Potassium, Uric Acid, LDH.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or
equal to 50K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to rituximab can occur and is most common with the first or second dose or if
greater than 6 months since last dose. For first and second dose patient should be treated in a location to optimize
emergency care. See Emergency Meds.
Monitoring Parameters (1)
Educate patients regarding the potential of occurence for severe mucocutaneous reactions with
rituximab.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes until rituximab infusion complete.
If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain, or hypotension, stop infusion
and contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the reaction
occurred.
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 10 UNIT/ML lock flush 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 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Days 1 through 6: Administer at 100 mL/hr continuously. When chemotherapy starts, keep TOTAL IV fluids at 100 mL/hr.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 2 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 5 doses Starting when released
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, nausea/vomiting, if unable to tolerate PO
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
rituximab (RITUXAN) 784 mg in sodium chloride 0.9 % 500 mL bag
784 mg (rounded from 783.75 mg = 375 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous,
ONCE, 1 dose Starting when released
Day 1: Hypersensitivity Risk. See Emergency Medications. Administer rituximab prior to any chemotherapy. See Note on
MAR for infusion rates. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain or
hypotension, contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the
reaction occurred.
prednisone (DELTASONE) tab 100 mg
100 mg, Oral, EVERY 24 HOURS, 6 doses Starting when released
Day 1-6: Administer first dose 30-60 minutes prior to start of chemotherapy.
etoposide (VEPESID) 105 mg, vinCRIStine (ONCOVIN) 0.8 mg, doxorubicin CONVENTIONAL (ADRIAMYCIN)
21 mg, sodium chloride 0.9 % 1,000 mL bag
Intravenous, EVERY 24 HOURS, 4 doses Starting when released
Day 1-4: Continuous infusion over 24 hours days 1 through 4 for a total of 96 hour. (etoposide Total dose = 200mg/m2,
vinCRIStine Total dose = 1.6 mg/m2, doxorubicin Total dose = 40 mg/m2.).
cyclophosphamide (CYTOXAN) 1,567.6 mg in sodium chloride 0.9 % 250 mL bag
1,567.6 mg (rounded from 1,567.5 mg = 750 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous
Administer on Day 5.
Cyclophosphamide dose less than 2000 mg infuse IV over 30 minutes.
Cyclophosphamide dose 2000 mg to 3999 mg infuse IV over 90 minutes.
Cyclophosphamide dose greater than 4000 mg infuse IV over 120 minutes.
Supportive Care Medications (delete all that do not apply)
allopurinol (ZYLOPRIM) tab 300 mg
300 mg, Oral, 1 X DAILY, 10 doses Starting S As Scheduled
Day 1-10: Administer daily during Cycle 1.
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting S As Scheduled
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
ranitidine (ZANTAC) tab 150 mg
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 3 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

150 mg, Oral, 1 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
1 tab, Oral, 2 X DAILY SAT, SUN Include Now
senna-docusate (SENOKOT S) 8.6-50 MG per tab 2 tab
2 tab, Oral, 1 X DAILY (HS) Starting S As Scheduled
Conditional Orders
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting,
If unable to tolerate PO., for 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
Take Home Medications (delete all that do not apply)
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Inject 300 mcg under skin one time daily in evening. Begin Day ***. Continue until ANC is greater than
*** after nadir., 300 mcg, Disp-10 Syringe, R-5, 1 X DAILY (PM) starting S, Local Printer
RPh may substitute filgrastim at an equivalent dose and qty based on insurance coverage.
TBO-filgrastim (GRANIX) 480 MCG/0.8ML soln prefilled syringe
Inject 480 mcg under skin one time daily in evening. Begin Day ***. Continue until ANC is greater than
*** after nadir., 480 mcg, Disp-10 Syringe, R-5, 1 X DAILY (PM) starting S, Local Printer
RPh may substitute filgrastim at an equivalent dose and qty based on insurance coverage.
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
INTERIM LAB APPOINTMENTS: CBC with DIFF every Monday and Thursday starting *** and
Creatinine, Potassium, Uric Acid, and LDH twice weekly for one week starting ***
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, DIFF,
hemoglobin, creatinine; NOTE: Admit to B6/6 through clinic for next Cycle.
Cycle 2 – 2/25/2016 through 3/16/2016 (21 days), Planned
Day 1 through 6 Inpatient, Cycle 2 – Planned for 2/25/2016 through 3/1/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma (Relapsed/ Refractory); THERAPY: rituximab 375 mg/m2 IV Day 1,
prednisone 100 mg by mouth Days 1 through 6, etoposide 50 mg/m2/day IV continuous infusion over 24 hours Day 1
through 4 (infuse over 96 hours: Total dose = 200 mg/m2), vinCRIStine 0.4 mg/m2/day IV continuous infusion over 24
hours Day 1 through 4 (infuse over 96 hours: Total dose = 1.6 mg/m2), doxorubicin 10 mg/m2/day IV continuous infusion
over 24 hours Day 1 through 4 (infuse over 96 hours: Total dose = 40 mg/m2), cyclophosphamide 750 mg/m2 IV Day 5;
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 21 to 28 days; COURSE: 4 to 6 cycles
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 4 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Note to All Staff (1)
This regimen is the non-dose adjusted version of R-EPOCH.
Note to All Staff (2)
Reactivation of hepatitis B virus (HBV) may occur and in some cases result in fulminant hepatitis, hepatic
failure, or death. Screen patients for HBV infection prior to rituximab treatment and consider prophylaxis against
reactivation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released, Routine
CREATININE
ONCE Starting when released, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or
equal to 50K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to rituximab can occur and is most common with the first or second dose or if
greater than 6 months since last dose. For first and second dose patient should be treated in a location to optimize
emergency care. See Emergency Meds.
Monitoring Parameters (1)
Educate patients regarding the potential of occurence for severe mucocutaneous reactions with
rituximab.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes until rituximab infusion complete.
If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain, or hypotension, stop infusion
and contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the reaction
occurred.
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 10 UNIT/ML lock flush 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.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 5 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Days 1 through 6: Administer at 100 mL/hr continuously. When chemotherapy starts, keep TOTAL IV fluids at 100 mL/hr.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 5 doses Starting when released
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, nausea/vomiting, if unable to tolerate PO
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
rituximab (RITUXAN) 784 mg in sodium chloride 0.9 % 500 mL bag
784 mg (rounded from 783.75 mg = 375 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous,
ONCE, 1 dose Starting when released
Day 1: Hypersensitivity Risk. See Emergency Medications. Administer rituximab prior to any chemotherapy. See Note on
MAR for infusion rates. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain or
hypotension, contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the
reaction occurred.
prednisone (DELTASONE) tab 100 mg
100 mg, Oral, EVERY 24 HOURS, 6 doses Starting when released
Day 1-6: Administer first dose 30-60 minutes prior to start of chemotherapy.
etoposide (VEPESID) 105 mg, vinCRIStine (ONCOVIN) 0.8 mg, doxorubicin CONVENTIONAL (ADRIAMYCIN)
21 mg, sodium chloride 0.9 % 1,000 mL bag
Intravenous, EVERY 24 HOURS, 4 doses Starting when released
Day 1-4: Continuous infusion over 24 hours days 1 through 4 for a total of 96 hour. (etoposide Total dose = 200mg/m2,
vinCRIStine Total dose = 1.6 mg/m2, doxorubicin Total dose = 40 mg/m2.).
cyclophosphamide (CYTOXAN) 1,567.6 mg in sodium chloride 0.9 % 250 mL bag
1,567.6 mg (rounded from 1,567.5 mg = 750 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous
Administer on Day 5.
Cyclophosphamide dose less than 2000 mg infuse IV over 30 minutes.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 6 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Cyclophosphamide dose 2000 mg to 3999 mg infuse IV over 90 minutes.
Cyclophosphamide dose greater than 4000 mg infuse IV over 120 minutes.
Supportive Care Medications (delete all that do not apply)
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting S As Scheduled
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
ranitidine (ZANTAC) tab 150 mg
150 mg, Oral, 1 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
1 tab, Oral, 2 X DAILY SAT, SUN Include Now
senna-docusate (SENOKOT S) 8.6-50 MG per tab 2 tab
2 tab, Oral, 1 X DAILY (HS) Starting S As Scheduled
Conditional Orders
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting,
If unable to tolerate PO., for 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
INTERIM LAB APPOINTMENTS: CBC with DIFF every Monday and Thursday starting ***.
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, DIFF,
hemoglobin, creatinine; NOTE: Admit to B6/6 through clinic for next Cycle.
Cycle 3 – 3/17/2016 through 4/6/2016 (21 days), Planned
Day 1 through 6 Inpatient, Cycle 3 – Planned for 3/17/2016 through 3/22/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma (Relapsed/ Refractory); THERAPY: rituximab 375 mg/m2 IV Day 1,
prednisone 100 mg by mouth Days 1 through 6, etoposide 50 mg/m2/day IV continuous infusion over 24 hours Day 1
through 4 (infuse over 96 hours: Total dose = 200 mg/m2), vinCRIStine 0.4 mg/m2/day IV continuous infusion over 24
hours Day 1 through 4 (infuse over 96 hours: Total dose = 1.6 mg/m2), doxorubicin 10 mg/m2/day IV continuous infusion
over 24 hours Day 1 through 4 (infuse over 96 hours: Total dose = 40 mg/m2), cyclophosphamide 750 mg/m2 IV Day 5;
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 21 to 28 days; COURSE: 4 to 6 cycles
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 7 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Note to All Staff (1)
This regimen is the non-dose adjusted version of R-EPOCH.
Note to All Staff (2)
Reactivation of hepatitis B virus (HBV) may occur and in some cases result in fulminant hepatitis, hepatic
failure, or death. Screen patients for HBV infection prior to rituximab treatment and consider prophylaxis against
reactivation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released, Routine
CREATININE
ONCE Starting when released, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or
equal to 50K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to rituximab can occur and is most common with the first or second dose or if
greater than 6 months since last dose. For first and second dose patient should be treated in a location to optimize
emergency care. See Emergency Meds.
Monitoring Parameters (1)
Educate patients regarding the potential of occurence for severe mucocutaneous reactions with
rituximab.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes until rituximab infusion complete.
If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain, or hypotension, stop infusion
and contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the reaction
occurred.
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 10 UNIT/ML lock flush 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.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 8 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Days 1 through 6: Administer at 100 mL/hr continuously. When chemotherapy starts, keep TOTAL IV fluids at 100 mL/hr.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 5 doses Starting when released
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, nausea/vomiting, if unable to tolerate PO
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
rituximab (RITUXAN) 784 mg in sodium chloride 0.9 % 500 mL bag
784 mg (rounded from 783.75 mg = 375 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous,
ONCE, 1 dose Starting when released
Day 1: Hypersensitivity Risk. See Emergency Medications. Administer rituximab prior to any chemotherapy. See Note on
MAR for infusion rates. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain or
hypotension, contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the
reaction occurred.
prednisone (DELTASONE) tab 100 mg
100 mg, Oral, EVERY 24 HOURS, 6 doses Starting when released
Day 1-6: Administer first dose 30-60 minutes prior to start of chemotherapy.
etoposide (VEPESID) 105 mg, vinCRIStine (ONCOVIN) 0.8 mg, doxorubicin CONVENTIONAL (ADRIAMYCIN)
21 mg, sodium chloride 0.9 % 1,000 mL bag
Intravenous, EVERY 24 HOURS, 4 doses Starting when released
Day 1-4: Continuous infusion over 24 hours days 1 through 4 for a total of 96 hour. (etoposide Total dose = 200mg/m2,
vinCRIStine Total dose = 1.6 mg/m2, doxorubicin Total dose = 40 mg/m2.).
cyclophosphamide (CYTOXAN) 1,567.6 mg in sodium chloride 0.9 % 250 mL bag
1,567.6 mg (rounded from 1,567.5 mg = 750 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous
Administer on Day 5.
Cyclophosphamide dose less than 2000 mg infuse IV over 30 minutes.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 9 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Cyclophosphamide dose 2000 mg to 3999 mg infuse IV over 90 minutes.
Cyclophosphamide dose greater than 4000 mg infuse IV over 120 minutes.
Supportive Care Medications (delete all that do not apply)
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting S As Scheduled
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
ranitidine (ZANTAC) tab 150 mg
150 mg, Oral, 1 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
1 tab, Oral, 2 X DAILY SAT, SUN Include Now
senna-docusate (SENOKOT S) 8.6-50 MG per tab 2 tab
2 tab, Oral, 1 X DAILY (HS) Starting S As Scheduled
Conditional Orders
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting,
If unable to tolerate PO., for 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
INTERIM LAB APPOINTMENTS: CBC with DIFF every Monday and Thursday starting ***.
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, DIFF,
hemoglobin, creatinine; NOTE: Admit to B6/6 through clinic for next Cycle.
Cycle 4 – 4/7/2016 through 4/27/2016 (21 days), Planned
Day 1 through 6 Inpatient, Cycle 4 – Planned for 4/7/2016 through 4/12/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma (Relapsed/ Refractory); THERAPY: rituximab 375 mg/m2 IV Day 1,
prednisone 100 mg by mouth Days 1 through 6, etoposide 50 mg/m2/day IV continuous infusion over 24 hours Day 1
through 4 (infuse over 96 hours: Total dose = 200 mg/m2), vinCRIStine 0.4 mg/m2/day IV continuous infusion over 24
hours Day 1 through 4 (infuse over 96 hours: Total dose = 1.6 mg/m2), doxorubicin 10 mg/m2/day IV continuous infusion
over 24 hours Day 1 through 4 (infuse over 96 hours: Total dose = 40 mg/m2), cyclophosphamide 750 mg/m2 IV Day 5;
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 21 to 28 days; COURSE: 4 to 6 cycles
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 10 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Note to All Staff (1)
This regimen is the non-dose adjusted version of R-EPOCH.
Note to All Staff (2)
Reactivation of hepatitis B virus (HBV) may occur and in some cases result in fulminant hepatitis, hepatic
failure, or death. Screen patients for HBV infection prior to rituximab treatment and consider prophylaxis against
reactivation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released, Routine
CREATININE
ONCE Starting when released, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or
equal to 50K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to rituximab can occur and is most common with the first or second dose or if
greater than 6 months since last dose. For first and second dose patient should be treated in a location to optimize
emergency care. See Emergency Meds.
Monitoring Parameters (1)
Educate patients regarding the potential of occurence for severe mucocutaneous reactions with
rituximab.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes until rituximab infusion complete.
If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain, or hypotension, stop infusion
and contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the reaction
occurred.
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 10 UNIT/ML lock flush 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.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 11 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Days 1 through 6: Administer at 100 mL/hr continuously. When chemotherapy starts, keep TOTAL IV fluids at 100 mL/hr.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 5 doses Starting when released
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, nausea/vomiting, if unable to tolerate PO
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
rituximab (RITUXAN) 784 mg in sodium chloride 0.9 % 500 mL bag
784 mg (rounded from 783.75 mg = 375 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous,
ONCE, 1 dose Starting when released
Day 1: Hypersensitivity Risk. See Emergency Medications. Administer rituximab prior to any chemotherapy. See Note on
MAR for infusion rates. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain or
hypotension, contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the
reaction occurred.
prednisone (DELTASONE) tab 100 mg
100 mg, Oral, EVERY 24 HOURS, 6 doses Starting when released
Day 1-6: Administer first dose 30-60 minutes prior to start of chemotherapy.
etoposide (VEPESID) 105 mg, vinCRIStine (ONCOVIN) 0.8 mg, doxorubicin CONVENTIONAL (ADRIAMYCIN)
21 mg, sodium chloride 0.9 % 1,000 mL bag
Intravenous, EVERY 24 HOURS, 4 doses Starting when released
Day 1-4: Continuous infusion over 24 hours days 1 through 4 for a total of 96 hour. (etoposide Total dose = 200mg/m2,
vinCRIStine Total dose = 1.6 mg/m2, doxorubicin Total dose = 40 mg/m2.).
cyclophosphamide (CYTOXAN) 1,567.6 mg in sodium chloride 0.9 % 250 mL bag
1,567.6 mg (rounded from 1,567.5 mg = 750 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous
Administer on Day 5.
Cyclophosphamide dose less than 2000 mg infuse IV over 30 minutes.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 12 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Cyclophosphamide dose 2000 mg to 3999 mg infuse IV over 90 minutes.
Cyclophosphamide dose greater than 4000 mg infuse IV over 120 minutes.
Supportive Care Medications (delete all that do not apply)
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting S As Scheduled
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
ranitidine (ZANTAC) tab 150 mg
150 mg, Oral, 1 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
1 tab, Oral, 2 X DAILY SAT, SUN Include Now
senna-docusate (SENOKOT S) 8.6-50 MG per tab 2 tab
2 tab, Oral, 1 X DAILY (HS) Starting S As Scheduled
Conditional Orders
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting,
If unable to tolerate PO., for 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
INTERIM LAB APPOINTMENTS: CBC with DIFF every Monday and Thursday starting ***.
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, DIFF,
hemoglobin, creatinine; NOTE: Admit to B6/6 through clinic for next Cycle.
Cycle 5 – 4/28/2016 through 5/18/2016 (21 days), Planned
Day 1 through 6 Inpatient, Cycle 5 – Planned for 4/28/2016 through 5/3/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma (Relapsed/ Refractory); THERAPY: rituximab 375 mg/m2 IV Day 1,
prednisone 100 mg by mouth Days 1 through 6, etoposide 50 mg/m2/day IV continuous infusion over 24 hours Day 1
through 4 (infuse over 96 hours: Total dose = 200 mg/m2), vinCRIStine 0.4 mg/m2/day IV continuous infusion over 24
hours Day 1 through 4 (infuse over 96 hours: Total dose = 1.6 mg/m2), doxorubicin 10 mg/m2/day IV continuous infusion
over 24 hours Day 1 through 4 (infuse over 96 hours: Total dose = 40 mg/m2), cyclophosphamide 750 mg/m2 IV Day 5;
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 21 to 28 days; COURSE: 4 to 6 cycles
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 13 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Note to All Staff (1)
This regimen is the non-dose adjusted version of R-EPOCH.
Note to All Staff (2)
Reactivation of hepatitis B virus (HBV) may occur and in some cases result in fulminant hepatitis, hepatic
failure, or death. Screen patients for HBV infection prior to rituximab treatment and consider prophylaxis against
reactivation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released, Routine
CREATININE
ONCE Starting when released, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or
equal to 50K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to rituximab can occur and is most common with the first or second dose or if
greater than 6 months since last dose. For first and second dose patient should be treated in a location to optimize
emergency care. See Emergency Meds.
Monitoring Parameters (1)
Educate patients regarding the potential of occurence for severe mucocutaneous reactions with
rituximab.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes until rituximab infusion complete.
If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain, or hypotension, stop infusion
and contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the reaction
occurred.
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 10 UNIT/ML lock flush 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.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 14 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Days 1 through 6: Administer at 100 mL/hr continuously. When chemotherapy starts, keep TOTAL IV fluids at 100 mL/hr.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 5 doses Starting when released
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, nausea/vomiting, if unable to tolerate PO
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
rituximab (RITUXAN) 784 mg in sodium chloride 0.9 % 500 mL bag
784 mg (rounded from 783.75 mg = 375 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous,
ONCE, 1 dose Starting when released
Day 1: Hypersensitivity Risk. See Emergency Medications. Administer rituximab prior to any chemotherapy. See Note on
MAR for infusion rates. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain or
hypotension, contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the
reaction occurred.
prednisone (DELTASONE) tab 100 mg
100 mg, Oral, EVERY 24 HOURS, 6 doses Starting when released
Day 1-6: Administer first dose 30-60 minutes prior to start of chemotherapy.
etoposide (VEPESID) 105 mg, vinCRIStine (ONCOVIN) 0.8 mg, doxorubicin CONVENTIONAL (ADRIAMYCIN)
21 mg, sodium chloride 0.9 % 1,000 mL bag
Intravenous, EVERY 24 HOURS, 4 doses Starting when released
Day 1-4: Continuous infusion over 24 hours days 1 through 4 for a total of 96 hour. (etoposide Total dose = 200mg/m2,
vinCRIStine Total dose = 1.6 mg/m2, doxorubicin Total dose = 40 mg/m2.).
cyclophosphamide (CYTOXAN) 1,567.6 mg in sodium chloride 0.9 % 250 mL bag
1,567.6 mg (rounded from 1,567.5 mg = 750 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous
Administer on Day 5.
Cyclophosphamide dose less than 2000 mg infuse IV over 30 minutes.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 15 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Cyclophosphamide dose 2000 mg to 3999 mg infuse IV over 90 minutes.
Cyclophosphamide dose greater than 4000 mg infuse IV over 120 minutes.
Supportive Care Medications (delete all that do not apply)
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting S As Scheduled
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
ranitidine (ZANTAC) tab 150 mg
150 mg, Oral, 1 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
1 tab, Oral, 2 X DAILY SAT, SUN Include Now
senna-docusate (SENOKOT S) 8.6-50 MG per tab 2 tab
2 tab, Oral, 1 X DAILY (HS) Starting S As Scheduled
Conditional Orders
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting,
If unable to tolerate PO., for 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
INTERIM LAB APPOINTMENTS: CBC with DIFF every Monday and Thursday starting ***.
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, DIFF,
hemoglobin, creatinine; NOTE: Admit to B6/6 through clinic for next Cycle.
Cycle 6 – 5/19/2016 through 6/8/2016 (21 days), Planned
Day 1 through 6 Inpatient, Cycle 6 – Planned for 5/19/2016 through 5/24/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Non-Hodgkin Lymphoma (Relapsed/ Refractory); THERAPY: rituximab 375 mg/m2 IV Day 1,
prednisone 100 mg by mouth Days 1 through 6, etoposide 50 mg/m2/day IV continuous infusion over 24 hours Day 1
through 4 (infuse over 96 hours: Total dose = 200 mg/m2), vinCRIStine 0.4 mg/m2/day IV continuous infusion over 24
hours Day 1 through 4 (infuse over 96 hours: Total dose = 1.6 mg/m2), doxorubicin 10 mg/m2/day IV continuous infusion
over 24 hours Day 1 through 4 (infuse over 96 hours: Total dose = 40 mg/m2), cyclophosphamide 750 mg/m2 IV Day 5;
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 21 to 28 days; COURSE: 4 to 6 cycles
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 16 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Note to All Staff (1)
This regimen is the non-dose adjusted version of R-EPOCH.
Note to All Staff (2)
Reactivation of hepatitis B virus (HBV) may occur and in some cases result in fulminant hepatitis, hepatic
failure, or death. Screen patients for HBV infection prior to rituximab treatment and consider prophylaxis against
reactivation.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
ONCE Starting when released, Routine
CREATININE
ONCE Starting when released, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or
equal to 50K/µL.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to rituximab can occur and is most common with the first or second dose or if
greater than 6 months since last dose. For first and second dose patient should be treated in a location to optimize
emergency care. See Emergency Meds.
Monitoring Parameters (1)
Educate patients regarding the potential of occurence for severe mucocutaneous reactions with
rituximab.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Monitor Vital Signs every 15 minutes for the first 60 minutes and then every 30 minutes until rituximab infusion complete.
If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain, or hypotension, stop infusion
and contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the reaction
occurred.
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 10 UNIT/ML lock flush 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.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 17 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Hydration
sodium chloride 0.9 % infusion
at 100 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
Days 1 through 6: Administer at 100 mL/hr continuously. When chemotherapy starts, keep TOTAL IV fluids at 100 mL/hr.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to rituximab.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, EVERY 24 HOURS, 5 doses Starting when released
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
ondansetron (ZOFRAN) 16 mg in sodium chloride 0.9 % 50 mL bag
16 mg, Intravenous, nausea/vomiting, if unable to tolerate PO
Days 1 through 5: Administer first dose prior to start of chemotherapy. May give IV if PO not tolerated.
Emergency Medications
diphenhydramine (BENADRYL) injection 25 mg
25 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, for 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 4 mg
4 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
rituximab (RITUXAN) 784 mg in sodium chloride 0.9 % 500 mL bag
784 mg (rounded from 783.75 mg = 375 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous,
ONCE, 1 dose Starting when released
Day 1: Hypersensitivity Risk. See Emergency Medications. Administer rituximab prior to any chemotherapy. See Note on
MAR for infusion rates. If patient experiences fever accompanied by chills or rigors, shortness of breath, chest pain or
hypotension, contact MD. Once the patient returns to baseline, infusion may be restarted at half the rate during which the
reaction occurred.
prednisone (DELTASONE) tab 100 mg
100 mg, Oral, EVERY 24 HOURS, 6 doses Starting when released
Day 1-6: Administer first dose 30-60 minutes prior to start of chemotherapy.
etoposide (VEPESID) 105 mg, vinCRIStine (ONCOVIN) 0.8 mg, doxorubicin CONVENTIONAL (ADRIAMYCIN)
21 mg, sodium chloride 0.9 % 1,000 mL bag
Intravenous, EVERY 24 HOURS, 4 doses Starting when released
Day 1-4: Continuous infusion over 24 hours days 1 through 4 for a total of 96 hour. (etoposide Total dose = 200mg/m2,
vinCRIStine Total dose = 1.6 mg/m2, doxorubicin Total dose = 40 mg/m2.).
cyclophosphamide (CYTOXAN) 1,567.6 mg in sodium chloride 0.9 % 250 mL bag
1,567.6 mg (rounded from 1,567.5 mg = 750 mg/m2 × 2.09 m2 Treatment plan actual BSA), Intravenous
Administer on Day 5.
Cyclophosphamide dose less than 2000 mg infuse IV over 30 minutes.
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Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org

Cyclophosphamide dose 2000 mg to 3999 mg infuse IV over 90 minutes.
Cyclophosphamide dose greater than 4000 mg infuse IV over 120 minutes.
Supportive Care Medications (delete all that do not apply)
acyclovir (ZOVIRAX) tab 400 mg
400 mg, Oral, 2 X DAILY Starting S As Scheduled
fluconazole (DIFLUCAN) tab 400 mg
400 mg, Oral, 1 X DAILY Starting when released
ranitidine (ZANTAC) tab 150 mg
150 mg, Oral, 1 X DAILY Starting when released
sulfamethoxazole-trimethoprim (BACTRIM DS) 800-160 MG per tab 1 tab
1 tab, Oral, 2 X DAILY SAT, SUN Include Now
senna-docusate (SENOKOT S) 8.6-50 MG per tab 2 tab
2 tab, Oral, 1 X DAILY (HS) Starting S As Scheduled
Conditional Orders
prochlorperazine (COMPAZINE) tab 10 mg
10 mg, Oral, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea
prochlorperazine (COMPAZINE) injection 10 mg
10 mg, Intravenous, EVERY 6 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
IV push slowly, max rate 5 mg/minute.
ondansetron (ZOFRAN) tab 8 mg
8 mg, Oral, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting
Do not exceed total of 24 mg ondansetron per 24 hours (scheduled and PRN)
ondansetron (ZOFRAN) injection 8 mg
8 mg, Intravenous, EVERY 8 HOURS PRN Starting when released Until Discontinued, nausea/vomiting,
If unable to tolerate PO., for 3 Minutes
Do not exceed total of 24 mg of ondansetron per 24 hours (scheduled and PRN). Administer over 3 to 5 minutes
Follow-Up
MULTIPLE DAY FOLLOW-UP (1)
INTERIM LAB APPOINTMENTS: CBC with DIFF every Monday and Thursday starting ***.
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, DIFF,
hemoglobin, creatinine; NOTE: Admit to B6/6 through clinic for next Cycle.
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Zztestonc,PedsBeiber [2668824]
2/4/2016 9:50:03 AM Page 19 of 19
Copyright © 201�University of Wisconsin Hospital and Clinics Authority, University of Wisconsin Medical Foundation, Inc, UW-Madison
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2016Lee Vermeulen, CCKM@uwhealth.org