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IP CAGT ALLOGENEIC SCT SAAMUD	

Types:      ONCOLOGY TREATMENT
Synonyms:  SAAMUD, MTX, METHOTREXATE, METHO, CYTOXAN, CYCLOPHOSPHAMIDE, CAMPATH, ALEMTUZUMAB, ALMETUZUMAB, BMT, CAGT, ALLOGENEIC, SCT

Transplant	Repeat 1 time	Cycle length: 90 days	Day -6 through -1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 64	Interval: Once	Occurrences: --	Comments:	Verify Hep B panel status prior to cycle. Date *** of panel. Result positive/negative/pending/unknown:22867

The required components for the hepatitis B panel includes: Hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B antibody (anti-HBs).
			Labs
  	CYTOMEGALOVIRUS ANTIGEN	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC > 1
		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC < 1
		  	FK506 TACROLIMUS LEVEL, RANDOM	Interval: Every Mon, Wed, Fri	Occurrences: --			Labs
  	ECG 12-LEAD	Interval: Daily	Occurrences: --	Comments:	Daily prior to cyclophosphamide doses
		  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: Daily	Occurrences: --			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) 16 mg, dexamethasone (DECADRON) 10 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	every 24 hours over 10 Minutes for 6 doses	Start: S			Instructions:	Administer 30 minutes prior to treatment on Days -6, -5, -4, -3, -2, -1.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	10 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes				Pre-Medications
  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to treatment on Days -6.			Antiemetics
  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) 16 mg, dexamethasone (DECADRON) 20 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	every 24 hours over 10 Minutes	Start: S			Instructions:	Administer 30 minutes prior to treatment on Days -6, -5, -4, -3, -2, -1.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION	Medications	16 mg	Main Ingredient	No	DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION	Medications	20 mg	Yes	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	50 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	50 mL	No	Yes				Pre-Medications
  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 30 minutes prior to treatment on Days -6.			Antiemetics
  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S					Chemotherapy
  	mesna (MESNEX) 20 mg/kg in sodium chloride 0.9% 100 mL chemo IVPB	Dose: 20 mg/kg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Day -6	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	MESNA 100 MG/ML INTRAVENOUS SOLUTION	Medications	20 mg/kg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	100 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes			  	cycloPHOSphamide (CYTOXAN) 50 mg/kg in dextrose 5% 500 mL chemo IVPB	Dose: 50 mg/kg	Route: intravenous	every 24 hours over 2 Hours for 4 doses			Offset: 1 Hours	Instructions:	Day -6, -5, -4, -3.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	CYCLOPHOSPHAMIDE 1 GRAM/50 ML INTRAVENOUS POWDER FOR SOLUTION (RECONSTITUTED VIAL)	Medications	50 mg/kg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	500 mL	No	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	500 mL	Yes	Yes			  	mesna (MESNEX) 10 mg/kg in sodium chloride 0.9% 100 mL chemo IVPB	Dose: 10 mg/kg	Route: intravenous	every 4 hours over 30 Minutes			Offset: 4.5 Hours	Instructions:	Day -6, -5, -4, -3.

Start 4 hours AFTER loading dose of Mesna.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	MESNA 100 MG/ML INTRAVENOUS SOLUTION	Medications	10 mg/kg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	100 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	 	No	Yes			  	alemtuzumab (CAMPATH) 10 mg in sodium chloride 0.9% 100 mL IVPB	Dose: 10 mg	Route: intravenous	every 24 hours over 2 Hours for 4 doses	Start: S+2			Instructions:	Day -4, -3, -2, -1.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ALEMTUZUMAB 30 MG/ML INTRAVENOUS SOLUTION	Medications	10 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	100 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	100 mL	No	Yes				Nursing Orders
  	ONC NURSING COMMUNICATION 27	Interval: Until discontinued	Occurrences: --	Comments:	Day -2, -1. Notify TMH Radiation Oncology (713-441-4800) of patient's admission and obtain time of TBI.
			Additional Orders
  	ONC NURSING COMMUNICATION 28	Interval: Until discontinued	Occurrences: --	Comments:	-12 lead EKG PRIOR to each dose of cyclophosphamide.

-Change IVF to Normal Saline at 125 mL/hr (MAX total volume infusion rate during chemotherapy = 350 mL/hr).

-Instruct patient to void every 1-2 hours DAILY x 5 days.
		  	sodium chloride 0.9 % infusion 1,000 mL	Dose: 1,000 mL	Route: intravenous	daily @ 125 mL/hr				Instructions:	Max total volume infusion rate during chemotherapy = 350 mL/hr.		  	sodium chloride 0.9 % infusion 1,000 mL	Dose: 1,000 mL	Route: intravenous	every 24 hours @ 42 mL/hr	Start: S+5			Instructions:	Max total volume infusion rate during chemotherapy = 350 mL/hr.

Starting Day -1.		  	ONC NURSING COMMUNICATION 7	Interval: Until discontinued	Occurrences: --	Comments:	During CYCLOPHOSPHAMIDE:
-12 lead EKG must be ordered and reviewed by physician prior to each dose.
-Starting 4 hours PRIOR to cyclophosphamide, change IVF to Normal Saline at 125 mL/hr and continue for 24 hours after last dose of cyclophosphamide completes.  (MAX total volume infusion rate during chemotherapy = 350 mL/hr).
-Instruct patient to void every 1-2 hours DAILY x 3 days.
		  	furosemide (LASIX) injection 20 mg	Dose: 20 mg	Route: intravenous	every 24 hours			Offset: 3 Hours	Instructions:	-Give at completion of each dose of cyclophosphamide infusion.		  	furosemide (LASIX) injection 20 mg	Dose: 20 mg	Route: intravenous	every 24 hours			Offset: 9 Hours	Instructions:	-Give 6 hours after above dose Q24H x 2 days		  	ONC NURSING COMMUNICATION 29	Interval: Daily	Occurrences: --	Comments:	-Monitor VS (temperature, pulse, respirations, and blood pressure) every 15 minutes during Alemtuzumab infusion and for 1 hour following completion.
-Continuous oxygen saturation monitoring during Alemtuzumab infusion and for 1 hour following completion. Keep oxygen at bedside through Day 0.
-STOP INFUSION and CONTACT MD if any of the following occur: shortness of breath, wheezing, chills, severe myalgia, hypotension, rash, or chest pain.
		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses	Start: S+2				  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	every 24 hours	Start: S+2			Instructions:	PREMED for ALEMTUZUMAB on Days -4, -3, -2, -1.		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	every 24 hours	Start: S+2			Instructions:	PREMED for ALEMTUZUMAB on Days -4, -3, -2, -1.		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	every 24 hours	Start: S+2			Instructions:	PREMED for ALEMTUZUMAB on Days -4, -3, -2, -1.			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN						Acute Graft Versus Host Prophylaxis
  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).				Day 0	Perform every 1 day x1		Labs
  	CYTOMEGALOVIRUS ANTIGEN	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC > 1
		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC < 1
		  	FK506 TACROLIMUS LEVEL, RANDOM	Interval: Once	Occurrences: --	Comments:	Draw on Day 0
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once for 1 dose				Instructions:	Premed for TRANSPLANT			Transplant Orders
  	ONC NURSING COMMUNICATION 55	Interval: Once	Occurrences: --	Comments:	-Oxygen at bedside during transplantation
-Anaphylaxis precautions at bedside during transplant:
		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses				Instructions:	Administer every 15 minutes x 3 doses PRN for each episode of rigors (if rigors persist, call MD).		  	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	once PRN	Start: S	End: S+2			  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once PRN	Start: S	End: S+2			  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once PRN						Acute Graft Versus Host Prophylaxis
  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).				Day 1 through 11	Perform every 1 day x1		Labs
  	CYTOMEGALOVIRUS ANTIGEN	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC > 1
		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC < 1
		  	FK506 TACROLIMUS LEVEL, RANDOM	Interval: Every Mon, Wed, Fri	Occurrences: --			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Day +1.		  	ondansetron (ZOFRAN) IV 8 mg	Dose: 8 mg	Route: intravenous	every 8 hours PRN	Start: S+1			Instructions:	Start on Day +2			Acute Graft Versus Host Prophylaxis
  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).		  	methotrexate Preservative Free 5 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 5 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S			Instructions:	HOLD UNTIL APPROVED BY CAGT. 

Day +1.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION	Medications	5 mg/m2	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	50 mL	No	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes			  	methotrexate Preservative Free 5 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 5 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S+2			Instructions:	HOLD UNTIL APPROVED BY CAGT. 

Day +3.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION	Medications	5 mg/m2	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	50 mL	No	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes			  	methotrexate Preservative Free 5 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 5 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S+5			Instructions:	HOLD UNTIL APPROVED BY CAGT. 

Day +6.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION	Medications	5 mg/m2	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	50 mL	No	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes			  	methotrexate Preservative Free 5 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 5 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S+10			Instructions:	HOLD UNTIL APPROVED BY CAGT. 

Day +11.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	METHOTREXATE SODIUM (PF) 25 MG/ML INJECTION SOLUTION	Medications	5 mg/m2	Main Ingredient	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	50 mL	No	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes