Protocol Index	

If this file opens in Compatibility Mode using Microsoft Word, convert to the latest document format to avoid potential formatting issues.	

IP CAGT AUTOLOGOUS SCT HIGH DOSE MELPHALAN	

Types:      ONCOLOGY TREATMENT
Synonyms:  MELPHALAN, ALKERAN, MELP, ALK, BMT, CAGT, AUTOLOGOUS, SCT

Transplant	Repeat 1 time	Cycle length: 90 days	Day -2 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					Pre-Medications
  	OLANZapine (ZYPREXA) tablet 10 mg	Dose: 10 mg	Route: oral	daily for 4 doses	Start: S  8:00 AM				  	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S  8:00 AM				  	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S  8:00 AM				  	ondansetron (ZOFRAN) tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours	Start: S+1  9:00 AM					Supportive Care
  	fluconazole (DIFLUCAN) tablet 200 mg	Dose: 200 mg	Route: oral	daily	Start: S				  	acyclovir (ZOVIRAX) tablet 800 mg	Dose: 800 mg	Route: oral	daily	Start: S				  	levoFLOXacin (LEVAQUIN) tablet 500 mg	Dose: 500 mg	Route: oral	daily at 0600 (TIME CRITICAL)	Start: S+3			Instructions:	Starting on Day +1.			Antiemetics
  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S					Provider Communication
  	ONC PROVIDER COMMUNICATION 28	Interval: --	Occurrences: --	Comments:	Okay to change medications to either IV or ODT formulation if patient is unable to tolerate oral.
			Chemotherapy
  	ONC NURSING COMMUNICATION 22	Interval: Once	Occurrences: --	Comments:	Provide ice chips and / or popsicles to patient 30 minutes prior, during and for 30 minutes following Melphalan infusion.
		  	melphalan HCL (ALKERAN) 200 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 200 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S  9:00 AM	End: S		Instructions:	Day -2.

Infuse within 60 minutes from vial reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	MELPHALAN HCL 50 MG INTRAVENOUS POWDER FOR SOLUTION	Medications	200 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN							Day 0	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	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+2			Instructions:	Start Day +3