Protocol Index	

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IP CAGT ALLOGENEIC SCT IV CLO-BU-CAM	

Types:      ONCOLOGY TREATMENT
Synonyms:  CLOLAR, CLOFARABINE, BUSULFEX, BUSULFAN, CAMPATH, ALMETUZUMAB, BMT

Transplant	Repeat 1 time	Cycle length: 87 days	Day -7 through -1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 64	Interval: Once	Occurrences: --	Comments:	Verify Hep B panel status prior to cycle. Date *** of panel. Result positive/negative/pending/unknown:22867

The required components for the hepatitis B panel includes: Hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B antibody (anti-HBs).
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Additional Orders
  	ONC NURSING COMMUNICATION 49	Interval: Until discontinued	Occurrences: --	Comments:	Do NOT administer Acetaminophen/Azoles for 48 hours after last busulfan dose.
			Pre-Medications
☑	ondansetron (ZOFRAN) 16 mg, dexamethasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	every 24 hours over 10 Minutes	Start: S+1  8:30 AM			Instructions:	Administer 30 minutes prior to treatment on Days -6, -5, -4, -3, -2, -1	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	12 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes			☑	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S+1  8:30 AM			Instructions:	Administer 30 minutes prior to treatment on Day -6			Antiemetics
☑	promethazine (PHENERGAN) injection 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 4 hours PRN	Start: S					Supportive Care
  	acyclovir (ZOVIRAX) 5 mg/kg (Ideal)	Dose: 5 mg/kg	Route: intravenous	every 8 hours	Start: S				  	levoFLOXacin (LEVAQUIN) tablet 500 mg	Dose: 500 mg	Route: oral	daily at 0600 (TIME CRITICAL) for 30 doses	Start: S				  	posaconazole (NOXAFIL) tablet (RESTRICTED) 300 mg	Dose: 300 mg	Route: oral	daily	Start: S+5			Instructions:	Start Day -2
Do NOT crush, split, or chew.  The delayed release tablet is NOT to interchange / substitute with oral posaconazole suspension.			Chemotherapy
  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	During IV Busulfan:
-INFUSE in the WHITE lumen on the TRIPLE lumen catheter
-LABEL the White lumen: Busulfan
-Prime tubing and filter with Normal Saline only
-Do NOT give any Acetaminophen (Tylenol) during Busulfan doses and for 48 hours following the last dose of Busulfan
-Record START and STOP time of EVERY Busulfan dose
-FLUSH tubing and filter with 20cc Normal Saline after each dose
		  	clofarabine (CLOLAR) 40 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 40 mg/m2	Route: intravenous	every 24 hours over 1 Hours for 4 doses	Start: S+1  9:00 AM			Instructions:	On Days -6, -5, -4, -3	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CLOFARABINE 1 MG/ML INTRAVENOUS SOLUTION	Medications	40 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	No	Yes			  	busulfan (BUSULFEX) 3.2 mg/kg in sodium chloride 0.9% chemo IVPB	Dose: 3.2 mg/kg	Route: intravenous	every 24 hours over 3 Hours for 2 doses	Start: S+1 10:00 AM			Instructions:	On Days -6, -5. 
**** Once DAILY dosing ****	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BUSULFAN 60 MG/10 ML INTRAVENOUS SOLUTION	Medications	3.2 mg/kg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	 	Yes	Yes			  	ONC NURSING COMMUNICATION 41	Interval: Daily	Occurrences: --	Comments:	-NO Acetaminophen.
-Monitor VS (temperature, pulse, respirations, and blood pressure) every 15 minutes during Alemtuzumab infusion and for 1 hour following completion.
-Continuous oxygen saturation monitoring during Alemtuzumab infusion and for 1 hour following completion. Keep oxygen at bedside through Day 0.
-STOP INFUSION and CONTACT MD if any of the following occur: shortness of breath, wheezing, chills, severe myalgia, hypotension, rash, or chest pain.
		  	alemtuzumab (CAMPATH) 10 mg in sodium chloride 0.9% 100 mL IVPB	Dose: 10 mg	Route: intravenous	every 24 hours over 2 Hours for 3 doses	Start: S+3 10:00 AM			Instructions:	Day -4, -3, -2	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ALEMTUZUMAB 30 MG/ML INTRAVENOUS SOLUTION	Medications	10 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	100 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	100 mL	No	Yes				Additional Orders
  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	every 24 hours	Start: S+3  9:00 AM			Instructions:	PREMED for ALEMTUZUMAB on Days -4, -3, -2		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	every 24 hours	Start: S+3  9:00 AM			Instructions:	PREMED for ALEMTUZUMAB on Days -4, -3, -2		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses	Start: S+3  9:00 AM			Instructions:	On Days -4, -3, -2			Seizure Prophylaxis
  	levETIRAcetam (KEPPRA) tablet	Dose: --	Route: oral	2 times daily	Start: S					VOD Prophylaxis
  	ursodioL (ACTIGALL) capsule 300 mg	Dose: 300 mg	Route: oral	3 times daily						Acute Graft Versus Host Prophylaxis
  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).			Day of Rest
  	ONC NURSING COMMUNICATION 48	Interval: Until discontinued	Occurrences: --	Comments:	Day -1.
				Day 0	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once for 1 dose				Instructions:	Premed for TRANSPLANT			Transplant Orders
  	ONC NURSING COMMUNICATION 55	Interval: Once	Occurrences: --	Comments:	-Oxygen at bedside during transplantation
-Anaphylaxis precautions at bedside during transplant:
		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses				Instructions:	Administer every 15 minutes x 3 doses PRN for each episode of rigors (if rigors persist, call MD).		  	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	once PRN	Start: S	End: S+2			  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once PRN	Start: S	End: S+2			  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once PRN							Day 1	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron ODT (ZOFRAN-ODT) disintegrating tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours PRN	Start: S+1			Instructions:	Start Day +1