Autologous Stem Cell Transplant Schedule with BEAM Conditioning

Canterbury DHB Stem Cell Transplant Schedule Department of Haematology Conditioning

Autologous SCT Schedule - BEAM conditioning Patient Pre Transplant Details Patient Name: DOB: NHI no: Referring Dr/Centre: GP: Consultant Height: Actual weight: Lean Body Weight: BSA Note: Dose reduction may be required if patient is more than 30% above lean body weight Diagnosis: Date of diagnosis: Date of admission: Date of discharge: Discharge: Hb g/L WCC x 109/L Neuts x 109/L Platelets 109/L Wt kg

PRE-TRANSPLANT ASSESSMENT: Previous chemo-radio therapy (significant total doses): Previous complications: Allergies/adverse reactions: Significant other illness: Disease status at transplant: Date documented: Performance status at transplant (Karnofsky): Outstanding investigations: Venous access: ABO/Rh group: RBC/HLA antibodies: HLA type: Respiratory function: Ejection fraction: GFR baseline: Respiratory viral screen: Swabs for staph aureus: Serology Positive for: Negative for: Date of dental assessment: Date Consent Signed:

Authorised by: Transplant consultant P Ganly BMT Coordinator A Trengrove 20 October 2010 D:\Docs\2017-12-17\009dba10320f1729a1fb08288b56e2bf.doc Page 1 of 5 Canterbury DHB Stem Cell Transplant Schedule Department of Haematology Conditioning

Transplant Protocol – Conditioning and Peritransplant Supportive Care

BLOOD PRODUCT SUPPORT: All blood products to be irradiated from 6 weeks prior to transplant and for at least 6 months. CMV negative blood products are not required.

CONDITIONING REGIME: Carmustine (BCNU) 300mg/m2 on day -6 only Etoposide 200mg/m2daily for 4 days, days -5, -4, -3, -2 Cytarabine 200mg/m2 BD for 4 days, days -5, -4, -3, -2 Melphalan 140mg/m2 on day –1 only (limit melphalan dose to 3.6mg/kg)

STEM CELL SOURCE: Bone Marrow/PBSC (Delete source which is not applicable) Date of Harvest: Re-infused Dose (CD34+): Ex vivo manipulation: Delete if none planned Other details:

ANTIEMETICS: Ondansetron 8mg Q12H +/- Dexamethasone 8 mg BD PO (stop prior to stem cell infusion) +/- Metoclopramide 10-20mg QID PO/IV +/- Cyclizine 50mg TDS PO/IV +/- Lorazepam 2mg PO PRN +/- Scopolamine patch changed every 3rd day

MENORRHAGIA PREVENTION: (delete if not female) Norethisterone 5mg TDS

SPECIAL NOTES FOR THIS PATIENT:

ANTI-MICROBIAL PROPHYLAXIS: NB: ADULT VERSION Protected environment: While neutrophils < 0.5 X 109/L PI diet: From admission for at least 6 weeks Neutropenic bacterial Not required routinely. prophylaxis: Antifungal prophylaxis: Fluconazole 200mg PO daily from day -3 until neutrophils > 0.5 X 109/L. HSV/VZV prophylaxis: If patient HSV seropositive and/or has had significant problems (delete option(s) which do not with HSV in past: Aciclovir 400mg PO BD to commence at start apply) of conditioning. Continue until discharge or 1 month post transplant (whichever is longer). CMV prevention: Only if patient is seropositive and considered at high risk for (delete option which does not CMV reactivation – eg prior treatment with fludarabine or is apply) severely immunocompromised: Monitor CMV DNA by quantitative PCR weekly from Day 10 until Day 60. PCP prophylaxis: Cotrimoxazole 960mg BD for 7 days, day –7 to day –1. Start cotrimoxazole again, 480mg PO daily, on stable engraftment. Continue for 6 months. If intolerant of cotrimoxazole, the alternative is dapsone 100mg PO daily, or pentamidine 300mg in 250mL 0.9S over 2 hours each month.

Daily Inpatient Transplant Schedule:

DAY DATE BMT DAY PLAN Time Thursday -8 Admit to ward, CBC + D, ONCO coag Friday -7 0730 Return to ward: Fluids only 0830 Hickman line insertion Urea, Magnesium, CRP, LFT’s LDH, Immunoglobulins, retics. 5ml EDTA for DNA storage to Molecular Biology (ext 89878). Commence allopurinol, antiemetics Commence cotrimoxazole 960mg BD for 7 days day –7 to day –1. 2000 1L 0.9S overnight Saturday -6 0930 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 1000 Carmustine (BCNU) (300mg/m2) mg in 250mL D5W over 2 hrs 1600 Check fluid balance/weight 2000 Ondansetron 8mg PO/IV and dexamethasone 8mg PO Sunday -5 0800 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 0830 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins 0900 Etoposide (200mg/m2) mg in 250mL 0.9S over 30 mins 1600 Check fluid balance/weight 2000 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 2030 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins Monday -4 0800 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 0830 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins 0900 Etoposide (200mg/m2) mg in 250mL 0.9S over 30 mins 1600 Check fluid balance/weight 2000 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 2030 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins Tuesday -3 0800 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 0830 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins 0900 Etoposide (200mg/m2) mg in 250mL 0.9S over 30 mins 1600 Check fluid balance/weight 2000 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 2030 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins Wednesday -2 0800 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 0830 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins 0900 Etoposide (200mg/m2) mg in 250mL 0.9S over 30 mins 1600 Check fluid balance/weight 2000 Ondansetron 8mg PO/IV and dexamethasone 8mg PO 2030 Cytarabine (200mg/m2) mg in 100mL 0.9S over 30 mins

Daily Inpatient Transplant Schedule (continued):

DAY DATE BMT DAY PLAN Time

Thursday -1 0830 0.9S 1L + 30mmol KCl over 1½ hours Stop allopurinol 0900 Dexamethasone 8mg PO, Ondansetron 8mg IV Please 0930 Frusemide 20-40mg IV stat – establish diuresis of at least contact lab, 500mL/hr. 3439095, Patient to have passed urine prior to starting infusion with time 1000 Melphalan (140mg/m2) mg slow IV bolus into fast running Melphalan 0.9S not exceeding ½ hour. infusion has 1030 0.9S 1L + 30mmol KCl over 1 ½ hours. Maintain urine finished output of at least 500mL/hr for 2 hours. Give frusemide 20- 40mg as necessary. 1200 0.9S 1L + 30 mmol KCl over 4 hours 1600 0.9S 1L + 30 mmol KCl over 6 hours 1600 Check fluid balance & weight, biochemistry if indicated 2200 0.9S 1L + 30 mmol KCl over 6 hours Friday 0 0400 0.9S 1L + 30 mmol KCl over 6 hours 0800 Check biochemistry Stop cotrimoxazole until stable engraftment 1000 D4S 1L + 30mmol KCl over 6 hours 1030 Frusemide 40mg IV, promethazine 6.25mgIV, ondansetron 8mg IV, hydrocortisone 100mg IV 1100 INFUSION OF HAEMATOPOIETIC STEM CELLS (must be >24hrs post melphalan) insert relevant reinfusion instruction from red book 1600 D4S 1L + 30mmol KCl over 6 hours 2200 Maintenance fluids as required

Protocol authorised by: NAME: SIGN: DATE: NAME: SIGN: DATE: CONSULTANTS (Original signed only)

Authorised by: Transplant consultant P Ganly BMT Coordinator A Trengrove 20 October 2010 D:\Docs\2017-12-17\009dba10320f1729a1fb08288b56e2bf.doc Page 5 of 5