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OP/IP RSH PRO00039683 YUEN PART A COHORT 1	

Types:      Research Oncology Treatment
Synonyms:  ANITOCABTAGENE AUTOLEUCEL

Lymphodepletion	Repeat 1 time	Cycle length: 5 days	Day -5 Outpatient	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 34	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:
		  	ONC NURSING COMMUNICATION 35	Interval: --	Occurrences: --	Comments:	Nursing Communication: Dose Modifications and Management for ***STUDY DRUG*** Treatment : : Refer to Section XXX (***TITLE***) Management of AEs Associated with ***STUDY DRUG***
Protocol Access Hyperlink:
			Nursing Orders
  	ONC NURSING COMMUNICATION 70	Interval: --	Occurrences: --	Comments:	Nursing Communications: Vital signs to be taken after patient has been resting for at least 5 minutes.
		  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	Blood pressure, body temperature, heart rate
			Nursing Orders
  	ONC NURSING COMMUNICATION 36	Interval: --	Occurrences: --	Comments:	Assess Adverse Events.LD chemo will be done from -5 to -3 days from Day 1 CAR-T infusion. There must be 2 day of rest between LD and Day 0 infusion.
		  	ONC NURSING COMMUNICATION 37	Interval: --	Occurrences: --	Comments:	Assess Concomitant Medications.

LD chemo will be done from -5 to -3 days from Day 0 CAR-T infusion
			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.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Hydration
  	sodium chloride 0.9 % infusion	Dose: 150 mL/hr	Route: intravenous	continuous	Start: S			Instructions:	Starting 1 hour prior to chemotherapy 			Pre-Medications
  	LORAZepam (ATIVAN) tablet 0.5 mg	Dose: 0.5 mg	Route: oral	once for 1 dose			Offset: 30 Minutes	Instructions:	
		  	palonosetron (ALOXI) injection 0.25 mg	Dose: 0.25 mg	Route: intravenous	once for 1 dose			Offset: 30 Minutes		  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose			Offset: 30 Minutes			Chemotherapy
  	INV-CYCLOPHOSPHAMIDE (NXC-201-AL-001/PRO00039683/YUEN) 250 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 250 mg/m2	Route: intravenous	once over 2 Hours for 1 dose			Offset: 60 Minutes	Instructions:	Infuse IV over 120 minutes.  Stable for 24 hours at room temperature (36 hours refrigerated).	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLN (NXC-201-AL-001/PRO00039683/YUEN)	Medications	250 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes			  	INV-FLUDARABINE (NXC-201-AL-001/PRO00039683/YUEN) INTRAVENOUS SOLN 25 mg/m2 (Treatment Plan)	Dose: 25 mg/m2	Route: intravenous	once for 1 dose			Offset: 3 Hours			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.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	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 -4 Outpatient	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 38	Interval: --	Occurrences: --	Comments:	Assess Adverse Events.LD chemo will be done  from -5 to -3 days from Day 0 CAR-T infusion
		  	ONC NURSING COMMUNICATION 47	Interval: --	Occurrences: --	Comments:	Assess Concomitant Medications. LD chemo will be done  from -5 to -3 days from Day 1 CAR-T infusion
			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.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Hydration
  	sodium chloride 0.9 % infusion	Dose: 150 mL/hr	Route: intravenous	continuous	Start: S			Instructions:	Starting 1 hour prior to chemotherapy 			Pre-Medications
  	LORAZepam (ATIVAN) tablet 0.5 mg	Dose: 0.5 mg	Route: oral	once for 1 dose			Offset: 30 Minutes	Instructions:	
			Chemotherapy
  	INV-CYCLOPHOSPHAMIDE (NXC-201-AL-001/PRO00039683/YUEN) 250 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 250 mg/m2	Route: intravenous	once over 2 Hours for 1 dose			Offset: 60 Minutes	Instructions:	Infuse IV over 120 minutes.  Stable for 24 hours at room temperature (36 hours refrigerated).	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLN (NXC-201-AL-001/PRO00039683/YUEN)	Medications	250 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes			  	INV-FLUDARABINE (NXC-201-AL-001/PRO00039683/YUEN) INTRAVENOUS SOLN 25 mg/m2 (Treatment Plan)	Dose: 25 mg/m2	Route: intravenous	once for 1 dose			Offset: 3 Hours			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.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	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 -3 Outpatient	Perform every 1 day x1			Research tolerance: -0/+0 days	Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION 52	Interval: --	Occurrences: --	Comments:	Assess Adverse Events.LD chemo will be done from -5 to -3 days from Day 0 CAR-T infusion
		  	ONC NURSING COMMUNICATION 53	Interval: --	Occurrences: --	Comments:	Assess Concomitant Medications.LD chemo will be done anywhere from -5 to -3 days from Day 0 CAR-T infusion
			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.
			Nursing Orders
  	TREATMENT CONDITIONS 7	Interval: --	Occurrences: --	Comments:	HOLD and notify provider if 
o ANC LESS than 1000; 
o Platelets LESS than 100,000.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Hydration
  	sodium chloride 0.9 % infusion	Dose: 150 mL/hr	Route: intravenous	continuous	Start: S			Instructions:	Starting 1 hour prior to chemotherapy 			Pre-Medications
  	LORAZepam (ATIVAN) tablet 0.5 mg	Dose: 0.5 mg	Route: oral	once for 1 dose			Offset: 30 Minutes	Instructions:	
			Pre-Medications
  	palonosetron (ALOXI) injection 0.25 mg	Dose: 0.25 mg	Route: intravenous	once for 1 dose			Offset: 30 Minutes			Chemotherapy
  	INV-CYCLOPHOSPHAMIDE (NXC-201-AL-001/PRO00039683/YUEN) 250 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 250 mg/m2	Route: intravenous	once over 2 Hours for 1 dose			Offset: 60 Minutes	Instructions:	Infuse IV over 120 minutes.  Stable for 24 hours at room temperature (36 hours refrigerated).	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-CYCLOPHOSPHAMIDE 1 GRAM INTRAVENOUS POWDER FOR SOLN (NXC-201-AL-001/PRO00039683/YUEN)	Medications	250 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes			  	INV-FLUDARABINE (NXC-201-AL-001/PRO00039683/YUEN) INTRAVENOUS SOLN 25 mg/m2 (Treatment Plan)	Dose: 25 mg/m2	Route: intravenous	once for 1 dose			Offset: 3 Hours			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.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once PRN	Start: S				  	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					
Inpatient Pre-Dose	Repeat 1 time	Cycle length: 10 days	Day 0 (CAR-T Infusion): Inpatient  Pre-Dose	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 67	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communications: Assess adverse events and concomitant medications;  ICE scoring to be done ONLY if symptoms of CRS. Collect concomitant medications.Collect adverse events.
		  	ONC NURSING COMMUNICATION 54	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam. To be done by PI or their delegate.
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: Once	Occurrences: --	Comments:	Prior to infusion, verify with pharmacy that 2 doses of tocilizumab are available and set aside for this patient.
			Nursing Orders
  	MEASURE WEIGHT	Interval: Once	Occurrences: --	Comments:	Vital signs to be done starting about 1 hour prior to the start of infusion and then post infusion should be performed approximately hourly for 4 hours following infusion.
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --	Comments:	Vital signs to be done starting about 1 hour prior to the start of infusion and then post infusion should be performed approximately hourly for 4 hours following infusion.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	PROTHROMBIN TIME WITH INR	Interval: Once	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Once	Occurrences: --	Comments:	This will be done weekly through Week 4
		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --	Comments:	This will be done twice weekly during Weeks 2 and 4
		  	INTERLEUKIN 6	Interval: Once	Occurrences: --	Comments:	This will be done twice weekly during Weeks 2 and 4
		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --	Comments:	This will be done twice weekly during Weeks 2 and 4
		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --	Comments:	This will be done twice weekly during Weeks 2 and 4
			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Administer 30 minutes before CAR-T infusion		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer 30 minutes before CAR-T infusion			Chemotherapy
  	INV-NKX-201 CAR-T cell infusion (NXC-201-AL-001/Pro00039683/Yuen) 150 Million Cells	Dose: 150 Million Cells	Route: intravenous	once for 1 dose			Offset: 30 Minutes	Instructions:	Treat as hazardous.  Infuse entire contents via gravity feed. Do not filter. Mulitple bags may be needed for the full dose. 
HAZARDOUS - Handle with care
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.			CAR-T Infusion Additional Orders
  	ONC NURSING COMMUNICATION 74	Interval: Once	Occurrences: --	Comments:	Transplant Orders: 
-Oxygen at bedside during CAR-T infusion and until discharged.
-Anaphylaxis precautions at bedside during CAR-T infusion and until discharged.
		  	ONC NURSING COMMUNICATION 75	Interval: Once	Occurrences: --	Comments:	- Obtain baseline vital signs (T, P, R, BP, Oxygen saturation +/- breath sounds) 
- Vital signs every 15 minutes during infusion (T, P, R, BP) 
- Vital signs (T, P, R, BP, +/- breath sounds) at completion of infusion, then at 30 minutes post & 60 minutes post infusion
		  	PULSE OXIMETRY CONTINUOUS	Interval: Continuous	Occurrences: --	Comments:	Continuous pulse oximetry monitoring during infusion and for 30 minutes post infusion
		  	ONC NURSING COMMUNICATION 80	Interval: Once	Occurrences: --	Comments:	RECORD START & STOP TIMES on component infusion form AND in EPIC
		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S				  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S					Discharge Nursing Orders
☑	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☐	HEParin, porcine 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.				Day 1	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.				Day 2	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.				Day 3	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			Nursing Orders
  	PROTHROMBIN TIME WITH INR	Interval: Once	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: Once	Occurrences: --			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.				Day 4	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.				Day 5	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.				Day 6	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.				Day 7	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	PROTHROMBIN TIME WITH INR	Interval: Once	Occurrences: --		  	PARTIAL THROMBOPLASTIN TIME (PTT)	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Once	Occurrences: --	Comments:	This will be done weekly through Week 4
		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --			Nursing Orders
  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.				Day 8	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 69	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs will be collected after the patient has been resting for at least 5 minutes. ICE score to be done only for signs of CRS. Collect concomitant medications. Collect adverse events.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.				Day 10	Perform every 1 day x1			Research tolerance: -0/+0 days	Nursing Orders
  	ONC NURSING COMMUNICATION 70	Interval: Until discontinued	Occurrences: --	Comments:	Nursing Communication: Vital signs to be done after the patient has rested for at least 5 minutes.  ICE scoring to be done only if signs of CRS.  Collect concomitant medications. Collect adverse events.  Instruct patient to collect temperature daily and record measurement in provided diary.
			Nursing Orders
  	ONC NURSING COMMUNICATION 68	Interval: Until discontinued	Occurrences: --	Comments:	Physical Exam.To be done by PI or their delegate
		  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --		  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	C-REACTIVE PROTEIN	Interval: Once	Occurrences: --		  	CREATINE KINASE, TOTAL (CPK)	Interval: Once	Occurrences: --		  	LACTATE DEHYDROGENASE (LDH)	Interval: Once	Occurrences: --		  	MAGNESIUM LEVEL	Interval: Once	Occurrences: --		  	PHOSPHORUS LEVEL	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --		  	FIBRINOGEN	Interval: Once	Occurrences: --		  	FERRITIN LEVEL	Interval: Once	Occurrences: --		  	BILIRUBIN DIRECT	Interval: Once	Occurrences: --		  	SEDIMENTATION RATE	Interval: Once	Occurrences: --		  	D-DIMER	Interval: Once	Occurrences: --		  	INTERLEUKIN 1 BETA	Interval: Once	Occurrences: --		  	INTERLEUKIN 6	Interval: Once	Occurrences: --		  	INTERLEUKIN-10, SERUM	Interval: Once	Occurrences: --		  	TUMOR NECROSIS FACTOR - ALPHA	Interval: Once	Occurrences: --			Research Labs
  	RESEARCH STUDY SPECIMEN	Interval: Once	Occurrences: --			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.