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HEM NHL Bendamustine(28D:1,2)/Rituximab(28:1) (3091 VER: 10-9-17)

HEM NHL Bendamustine(28D:1,2)/Rituximab(28:1) (3091 VER: 10-9-17) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 11-29-17 (3091 VER: 10-9-17) Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Bendamustine/Rituximab
Disease Group: Hematology
Disease: Non-Hodgkin Lymphoma

Therapy: rituximab 375 mg/m2 IV Day 1,
bendamustine 90 mg/m2 IV Day 1 and 2

Cycle Length: 28 days Course: 6 to 8 cycles

Note to all Staff (1): Monitor patients for skin reactions. Cases of Stevens-Johnson syndrome (SJS) and toxic
epidermal necrolysis (TEN), some fatal, have been reported when bendamustine was administered
concomitantly with allopurinol and other medications known to cause these syndromes. Consider risk versus
benefit of allopurinol prophylaxis based on tumor lysis burden and risk for tumor lysis initiation of treatment.

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.

Reference(s): Robinson KS, et al. J Clin Oncol (2008);26:4473-9, Rummel MJ, et al. J Clin Oncol
(2005);23:3383-9, McLaughlin P, et al. Oncology 1998;12:1762-9.


Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


Cycle _______ Starting with:  Day 1 (date) ___________  Day 2 (date) ___________

Pre labs:
• Cycle 1, Day 1: Obtain CBC without DIFF, ANC, Creatinine, Potassium, Uric Acid, LDH, Total Bilirubin, AST,
ALT, Hepatitis B Core Antibody (Total), Hepatitis B Surface Antigen, Hepatitis B Surface Antibody, Hepatitis B
DNA Ultra Quantitative PCR (obtain only if Hepatitis B Core Antibody is positive)
 Other:


• Cycle ≥ 2, Day 1: Obtain CBC without DIFF, ANC, Creatinine, Total Bilirubin, AST, ALT
 Other:


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Cycle 1, Day 1: Verify the following labs have been obtained: CBC, ANC, Creatinine, Potassium, Uric Acid,
LDH, AST, ALT, Total Bilirubin
• Cycle ≥ 2, Day 1: Verify the following labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total
Bilirubin
• Day 1: Hold and notify provider for: ANC ≤ 1000/µL or Platelets ≤ 75K/µL or Creatinine Clearance ≤ 40 mL/min
or AST > 2.5 X ULN or ALT > 2.5 X ULN or Total Bilirubin > 1.5 X ULN


VER: 11-29-17 (3091 VER: 10-9-17) Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Nursing Procedure, Assessment and Monitoring:
• Educate/reinforce with patient regarding the potential of occurrence for severe mucocutaneous reactions with
rituximab.
• 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/Line Care per Institution standards

Hydration/Fluids: sodium chloride 0.9% IV to establish line and for flushing

Premedications/Antiemetics: (May substitute formulary equivalent)
Day 1 and 2: Give prior to chemotherapy:
• acetaminophen (Tylenol) 650 mg by mouth once.
• diphenhydramine (Benadryl) 25 mg by mouth once

Day 1 and 2: Give prior to chemotherapy (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 16 mg by mouth once. PO preferred – may give 8 mg IV if unable to tolerate PO.
 *dexamethasone (Decadron) 10 mg by mouth once. PO preferred – may give 10 mg IV if unable to tolerate
PO.
 fosaprepitant (Emend) 150 mg IV once.
 aprepitant (Emend) 125 mg by mouth once.
 palonosetron (Aloxi) 0.25 mg IV once.
 Other:

Treatment Medications for Day 1: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:


• rituximab (Rituxan) __________mg (375 mg/m2) IV once.
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. Begin infusion at 50 mg/hr. If hypersensitivity or infusion-related events do not occur,
increase infusion rate in 50 mg/hr increments every 30 minutes to a maximum rate of 400 mg/hr. If patient
experiences fever accompanied by chills or rigors, shortness of breath, chest pain or hypotension, contact MD.
Once patient returns to baseline, infusion may be restarted at half the rate during which the reaction occurred.


• bendamustine (Bendeka) __________mg (90 mg/m2) IV once over 10 minutes. Hypersensitivity reaction to
bendamustine can occur. For first and second dose, patient should be treated in a location to optimize
emergency care.

Treatment Medications for Day 2: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:


• bendamustine (Bendeka) __________mg (90 mg/m2) IV once over 10 minutes. Hypersensitivity reaction to
bendamustine can occur. For first and second dose, patient should be treated in a location to optimize
emergency care.

VER: 11-29-17 (3091 VER: 10-9-17) Page 3 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Other Orders for Day 1 and/or 2:



Take Home Medications - (Prescribe Cycle 1, Day 1: Review for adequate supply during treatment)
• ondansetron (Zofran) 8 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (8 mg) by mouth every 8 hours as needed for nausea/vomiting.

• prochlorperazine (Compazine) 10 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (10 mg) by mouth every 6 hours as needed for nausea/vomiting.

• acyclovir (Zovirax) 400 mg tablet, Disp. #60, Refills: 5
Take 1 tablet (400 mg) by mouth two times daily.

 aprepitant (Emend) 80 mg capsule, Disp. #2, Refills: 5
Take 1 capsule by mouth once daily for two days following chemotherapy.
(Prescribe only if patient received aprepitant as a premedication)

 Other:


Follow Up
• Chemotherapy: Day 1 and 2 every 28 days

• Labs:
 Day 10 – Obtain CBC, ANC (DIFF if done locally)
 Other:


• Procedures/Imaging/Scans:






• Other Orders:






MD Signature_________________________________________ Pager______________
Date __________________Time___________________

Order Verification:
RN Signature: __________________________ Date: ___________ Time: __________ Pager #: ________
RPh Signature: _________________________ Date: ___________ Time: __________ Pager #: ________