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OP RESEARCH PRO00038209 / A062102 GANGULY IBERDOMIDE	

Types:      Research Oncology Treatment
Synonyms:  MULTIPLE MYELOMA

Cycle 1	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	History and full physical examination:  As clinically indicated for patients assigned to observation.  IT Beacon Build- Nursing Communication for CRC & Treating Team to Collect or order
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 2	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 3	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 4	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 5	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 6	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 7	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 8	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 9	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 10	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 11	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 12	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 13	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 14	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 15	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 16	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 17	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 18	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 19	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
Cycle 20	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Patient Medication Diary:  The diary must begin the day the patient starts taking iberdomide and must be completed per protocol and returned to the treating institution OR compliance must be documented in the medical record by any member of the care team. For patients taking iberdomide only.
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Procedures
☑	PET CT WHOLE BODY	Interval: --	Occurrences: --	Comments:	CT/MRI/PET:  <= 42 DAYS before registration:  Whole body imaging should be performed within 45 days of cycle 1 day 1. Whole body PET-CT is required only for patients with known extramedullary myeloma. All other patients may complete other whole body skeletal imaging, including x-ray skeletal survey, whole-body low-dose CT, or whole-body MRI.
		☑	MRI WHOLE BODY	Interval: --	Occurrences: --	Comments:	EMP Radiological Assessment (only required if history of or clinical indication of EMP):   Whole-body fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET-CT), or whole-body magnetic resonance imaging (MRI), or CT/MRI of involved regions is required.  Imaging performed within 60 days prior to consent is acceptable. See Section 9.1.2.1 for details.
		☑	XR BONE SURVEY SKELETAL	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Pregnancy Prevention Counseling:  The Iberdomide Education and Counseling Guidance Document (Appendices VI and VII) for each gender (female and male) must be completed and signed by a trained counselor at the site prior to each dispensing of iberdomide. A copy of this document must be maintained in the subject's records for each dispense. The Iberdomide Information Sheet (Appendix IV) will be given to each patient receiving iberdomide treatment. The patient must read this document prior to starting iberdomide study treatment and each time they receive a new supply of study drug For patients taking iberdomide only.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Dispense Iberdomide For patients taking iberdomide only:  Only enough iberdomide for 28 days or one cycle of study treatment (whichever is shorter) may be provided to the patient each cycle.
			Provider Communication
  	ONC NURSING COMMUNICATION 5	Interval: --	Occurrences: --	Comments:	Iberdomide:  Daily for 21 days each cycle:  Take by mouth with or without food. Capsules should be swallowed whole and taken with water and not crushed, chewed or opened. If patients miss a dose, the dose may still be taken up to 12 hours after the time they normally would take it. If more than 12 hours have elapsed, the dose should be skipped. Take the next dose at the usual time. Patients should not take 2 doses to make up for the one they missed. If patients vomit after taking the dose, do not repeat the dose.  Skip the vomited dose and take the next dose as the scheduled time.  Paper prescription order form must be submitted to IDS.
		  	ONC NURSING COMMUNICATION 25	Interval: --	Occurrences: --	Comments:	Thromboprophylaxis (recommended per provider discretion)
		  	ONC NURSING COMMUNICATION 15	Interval: --	Occurrences: --	Comments:	Antimicrobials (recommended when patient experiences neutropenia)
		  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Bone modifying agents (recommended as clinically indicated)
			Medications
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	2 times daily	Start: S			Instructions:	Valacyclovir:  HSV prophylaxis - oral 500 mg BID (REQUIRED - may choose alternate agent)		  	pentamidine (NEBUPENT) 300 mg in sterile water (PF) 6 mL inhalation solution	Dose: 300 mg	Route: nebulization	user specified	Start: S			Instructions:	Dissolve one vial (300 mg) pentamidine in 6 mL sterile water for injection. Place the entire reconstituted contents of the vial into the Respirgard II nebulizer reservoir for administration.  Pentamidine:  PJP prophylaxis - 300 mg Inh q28d (REQUIRED - may choose alternate agent); Once a month	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	PENTAMIDINE 300 MG SOLUTION FOR INHALATION	Medications	300 mg	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	6 mL	Yes	Yes				Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mg/dL; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			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.			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only - itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 - MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms - shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Cetirizine 10 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	cetirizine (ZyrTEC) tablet 10 mg	Dose: 10 mg	Route: oral	once PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			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.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled					
EOT	Repeat 1 time	Cycle length: 90 days	Day 1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	History and full physical examination:  As clinically indicated for patients assigned to observation.  IT Beacon Build- Nursing Communication for CRC & Treating Team to Collect or order
			Nursing Orders
☑	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	Adverse Event Assessment:  As clinically indicated for patients assigned to observation. C1D15 For patients taking iberdomide only
			Labs
☑	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --	Comments:	Serum HCG:  For women of childbearing potential (see Section 3.3). A female of childbearing potential (FCBP) is a female who: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy;or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months). Pregnancy tests must occur within 10 - 14 days and again within 24 hours prior to initiation of iberdomide. FCBP with regular or no menstruation must have a pregnancy test weekly for the first 28 days and then every 28 days while on study treatment (including breaks in treatment); at discontinuation of iberdomide and at day 28 post the last dose of iberdomide. Females with irregular menstruation must have a pregnancy test weekly for the first 28 days and then every 14 days while on study treatment (including breaks in treatment), at 
discontinuation of iberdomide and at Day 14 and Day 28 post the last dose of iberdomide (see Appendix V:Iberdomide Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods).
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	BIOPSY BONE MARROW	Interval: --	Occurrences: --	Comments:	Bone marrow biopsy and aspirate:  For patients who were not in CR/sCR at pre-registration, bone marrow aspirate and biopsy at achievement of CR/sCR while on study is standard of care and mandatory. Regarding specifically the cycle 12 (+/- 1 month) bone marrow aspirate and biopsy, if that is being done to confirm CR/sCR, this bone marrow testing is also and again mandatory. If cycle 12 bone marrow biopsy is not being done to confirm CR/sCR, rather only for optional, consented sample collection, then this bone marrow testing is optional. In all scenarios, standard of care MRD testing is recommended as per standard of care if patient is in CR/sCR. Additionally, samples for study MRD testing also will be collected if patient has consented to biobanking. MRD original reports should be uploaded into Rave.
			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Labs
  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --		  	RESEARCH STUDY SPECIMEN	Interval: --	Occurrences: --			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.
					
Follow Up	Repeat 1 time	Cycle length: 90 days	Day 1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Please refer to Study Protocol for any questions or discrepancies. See Schedule of Events Calendar for sequence of diagnostic tests, examinations, and treatment administration: See Safety Parameters-for Toxicity Management and Dose Modification Guidelines: Protocol Access hyperlink:  A062102_Ganguly
		  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for IBERDOMIDE Treatment : Refer to Section 8.2 Protocol Access Hyperlink:  A062102_Ganguly
			Nursing Orders
  	ONC NURSING COMMUNICATION 16	Interval: --	Occurrences: --	Comments:	History and symptom directed physical exam:  As clinically indicated for patients assigned to observation.  C1D15 For patients taking iberdomide only.
			Nursing Orders
☑	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Vitals Signs:  As clinically indicated for patients assigned to observation.
			Labs
☑	SERUM ELECTROPHORESIS	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	IMMUNOFIXATION (IFE) AND IMMUNOGLOBULINS PANEL (IGG, IGA,IGM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	KAPPA LIGHT CHAIN, FREE, SERUM	Interval: --	Occurrences: --	Comments:	Serum protein electrophoresis, serum immunofixation, quantitative immunoglobulins, serum free light chains:  As clinically indicated for patients assigned to observation.
		☑	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --	Comments:	Complete blood count (CBC) with differential:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
		☑	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --	Comments:	Complete metabolic profile:  As clinically indicated for patients assigned to observation. D15 ONLY FOR PATIENTS TAKING IBERDOMIDE
			Labs
☑	URINE PROTEIN ELECTROPHORESIS, RANDOM	Interval: --	Occurrences: --	Comments:	24-hour urine protein electrophoresis and immunofixation:  As clinically indicated for patients assigned to observation.  For patients who had measurable disease by urine by IMWG criteria (urinary M-spike of 200 mg/24 hour) within 12 months of study registration OR patients for whom that is unknown, perform this assessment monthly.  Other patients should perform this every three cycles starting with cycle 3.