Protocol Index	

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IP CLAG	

Types:      ONCOLOGY TREATMENT
Synonyms:  AML, CLAG, CLADRI, FILGR, CYTOSA, LEUST, ARA

Cycle 1	Repeat 1 time	Cycle length: 8 days	Day 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).
			Provider Communication
  	ONC PROVIDER COMMUNICATION 5	Interval: Once	Occurrences: --	Comments:	Use baseline weight to calculate dose. Adjust dose for weight gains/losses of greater than or equal to 10%.
			Labs
☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		☑	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		☑	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		☐	LDH	Interval: Once	Occurrences: --		☐	URIC ACID LEVEL	Interval: Once	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION 27	Interval: Once	Occurrences: --	Comments:	Start neupogen 24 hours before cladribine, if WBC is greater than 20,000, start on day 1.
			Nursing Orders
  	ONC NURSING COMMUNICATION 81	Interval: Once	Occurrences: --	Comments:	Okay to give neupogen with chemotherapy.
			Supportive Care
  	filgrastim-sndz (ZARXIO) injection solution 300 mcg	Dose: 300 mcg	Route: subcutaneous	once for 1 dose	Start: S			Rule-Based Template: RULE ONCBCN NEUPOGEN WEIGHT BASED	  Conditions:	  Modifications:	  Weight > 78 kg	  Set dose to 480 mcg	  Weight <= 78 kg	  Set dose to 300 mcg				Day 2	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION 81	Interval: Once	Occurrences: --	Comments:	Okay to give neupogen with chemotherapy.
			Supportive Care
  	filgrastim-sndz (ZARXIO) injection solution 300 mcg	Dose: 300 mcg	Route: subcutaneous	once for 1 dose	Start: S			Rule-Based Template: RULE ONCBCN NEUPOGEN WEIGHT BASED	  Conditions:	  Modifications:	  Weight > 78 kg	  Set dose to 480 mcg	  Weight <= 78 kg	  Set dose to 300 mcg			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Hydration
  	sodium chloride 0.9 % infusion	Dose: 100 mL/hr	Route: intravenous	continuous	Start: S					Supportive Care
  	prednisoLONE acetate (PRED FORTE) 1 % ophthalmic suspension 2 drop	Dose: 2 drop	Route: Both Eyes	every 4 hours while awake	Start: S					Pre-Medications
☑	ondansetron (ZOFRAN) 16 mg, dexamethasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			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			☐	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S				☐	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S				☐	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S					Chemotherapy
  	cladribine (LEUSTATIN) 5 mg/m2 in sodium chloride 0.9 % 500 mL chemo IVPB	Dose: 5 mg/m2	Route: intravenous	once over 2 Hours for 1 dose			Offset: 30 Minutes	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION	Medications	5 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	500 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Once	Occurrences: --	Comments:	Have patient sign name as cerebellar assessment prior to each dose of Cytarabine.
			Nursing Orders
  	ONC NURSING COMMUNICATION 70	Interval: Once	Occurrences: --	Comments:	Begin cytarabine 2 hours after completion of cladribine.
			Chemotherapy
  	cytarabine PF (CYSTOSAR) 2,000 mg/m2 in dextrose 5% 250 mL chemo IVPB	Dose: 2,000 mg/m2	Route: intravenous	once over 120 Minutes for 1 dose			Offset: 4.5 Hours	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION	Medications	2,000 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	No	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.				Days 3,4,5	Perform every 1 day x3		Nursing Orders
  	ONC NURSING COMMUNICATION 81	Interval: Once	Occurrences: --	Comments:	Okay to give neupogen with chemotherapy.
			Supportive Care
  	filgrastim-sndz (ZARXIO) injection solution 300 mcg	Dose: 300 mcg	Route: subcutaneous	once for 1 dose	Start: S			Rule-Based Template: RULE ONCBCN NEUPOGEN WEIGHT BASED	  Conditions:	  Modifications:	  Weight > 78 kg	  Set dose to 480 mcg	  Weight <= 78 kg	  Set dose to 300 mcg			Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Supportive Care
  	prednisoLONE acetate (PRED FORTE) 1 % ophthalmic suspension 2 drop	Dose: 2 drop	Route: Both Eyes	every 4 hours while awake	Start: S					Pre-Medications
☑	ondansetron (ZOFRAN) 16 mg, dexamethasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			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			☐	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S				☐	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S				☐	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S					Chemotherapy
  	cladribine (LEUSTATIN) 5 mg/m2 in sodium chloride 0.9 % 500 mL chemo IVPB	Dose: 5 mg/m2	Route: intravenous	once over 2 Hours for 1 dose			Offset: 30 Minutes	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION	Medications	5 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	500 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Once	Occurrences: --	Comments:	Have patient sign name as cerebellar assessment prior to each dose of Cytarabine.
			Nursing Orders
  	ONC NURSING COMMUNICATION 70	Interval: Once	Occurrences: --	Comments:	Begin cytarabine 2 hours after completion of cladribine.
			Chemotherapy
  	cytarabine PF (CYSTOSAR) 2,000 mg/m2 in dextrose 5% 250 mL chemo IVPB	Dose: 2,000 mg/m2	Route: intravenous	once over 120 Minutes for 1 dose			Offset: 4.5 Hours	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION	Medications	2,000 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	No	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes					Day 6	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION 81	Interval: Once	Occurrences: --	Comments:	Okay to give neupogen with chemotherapy.
			Supportive Care
  	filgrastim-sndz (ZARXIO) injection solution 300 mcg	Dose: 300 mcg	Route: subcutaneous	once for 1 dose	Start: S			Rule-Based Template: RULE ONCBCN NEUPOGEN WEIGHT BASED	  Conditions:	  Modifications:	  Weight > 78 kg	  Set dose to 480 mcg	  Weight <= 78 kg	  Set dose to 300 mcg			Line Care
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
☑	ondansetron (ZOFRAN) 16 mg, dexamethasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	once over 10 Minutes for 1 dose	Start: S			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			☐	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S				☐	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S				☐	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S					Chemotherapy
  	cladribine (LEUSTATIN) 5 mg/m2 in sodium chloride 0.9 % 500 mL chemo IVPB	Dose: 5 mg/m2	Route: intravenous	once over 2 Hours for 1 dose			Offset: 30 Minutes	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CLADRIBINE 10 MG/10 ML INTRAVENOUS SOLUTION	Medications	5 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	500 mL	Yes	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Once	Occurrences: --	Comments:	Have patient sign name as cerebellar assessment prior to each dose of Cytarabine.
			Nursing Orders
  	ONC NURSING COMMUNICATION 70	Interval: Once	Occurrences: --	Comments:	Begin cytarabine 2 hours after completion of cladribine.
			Chemotherapy
  	cytarabine PF (CYSTOSAR) 2,000 mg/m2 in dextrose 5% 250 mL chemo IVPB	Dose: 2,000 mg/m2	Route: intravenous	once over 120 Minutes for 1 dose			Offset: 4.5 Hours	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJECTION SOLUTION	Medications	2,000 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	No	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes