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IP CAGT ALLOGENEIC SCT FLU-MEL-CAM	

Types:      ONCOLOGY TREATMENT
Synonyms:  FLU, FLUDARA, MELPHALAN, ALKERAN, SARCOLYSIN, ALEMTUZUMAB, ALAN, BMT, CAGT, ALLOGENEIC, SCT, FLUMELCAM

Transplant	Repeat 1 time	Cycle length: 90 days	Days -5 through -1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 64	Interval: Once	Occurrences: --	Comments:	Verify Hep B panel status prior to cycle. Date *** of panel. Result positive/negative/pending/unknown:22867

The required components for the hepatitis B panel includes: Hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B antibody (anti-HBs).
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	ondansetron (ZOFRAN) tablet 8 mg	Dose: 8 mg	Route: oral	every 24 hours for 4 doses	Start: S			Instructions:	Day -5 through Day -2		  	OLANZapine (ZYPREXA) tablet 10 mg	Dose: 10 mg	Route: oral	daily for 4 doses	Start: S+4  8:00 AM			Instructions:	Day -1 through Day +2		  	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S+4  8:00 AM			Instructions:	Day -1 prior to Melphalan		  	dexamethasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S+4  8:00 AM			Instructions:	Day -1 prior to Melphalan		  	ondansetron (ZOFRAN) tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours for 10 doses	Start: S+4  9:00 PM					Supportive Care
  	acyclovir (ZOVIRAX) 5 mg/kg (Ideal)	Dose: 5 mg/kg	Route: intravenous	every 8 hours	Start: S				  	fluconazole (DIFLUCAN) tablet 200 mg	Dose: 200 mg	Route: oral	daily	Start: S				  	levoFLOXacin (LEVAQUIN) tablet 500 mg	Dose: 500 mg	Route: oral	daily at 0600 (TIME CRITICAL)	Start: S+8			Instructions:	Start Day +3			Antiemetics
  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S					Chemotherapy
  	fludarabine (FLUDARA) 30 mg/m2 in sodium chloride 0.9% 100 mL chemo IVPB	Dose: 30 mg/m2	Route: intravenous	every 24 hours over 30 Minutes for 4 doses				Instructions:	Day -5, -4, -3, -2.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION	Medications	30 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	100 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	100 mL	No	Yes				Additional Orders
  	ONC NURSING COMMUNICATION 44	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.
			Chemotherapy
  	alemtuzumab (CAMPATH) 10 mg in sodium chloride 0.9% 100 mL IVPB	Dose: 10 mg	Route: intravenous	every 24 hours over 2 Hours for 3 doses	Start: S+1			Instructions:	Day -4, -3, -2.	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			  	TRANSFUSION REACTION EVALUATION	Interval: Until discontinued	Occurrences: --	Comments:	Ice chips and / or popsicles to patient 30 minutes prior, during and for 30 minutes following Melphalan infusion.
		  	ONC NURSING COMMUNICATION 30	Interval: Once	Occurrences: --	Comments:	Administer Melphalan NO later than 10:00 am.
		  	melphalan HCL (ALKERAN) 140 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 140 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S+4  9:00 AM			Instructions:	Day -1.

Infuse within 60 minutes from vial reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	MELPHALAN HCL 50 MG/10 ML INTRAVENOUS POWDER FOR SOLUTION (RECONSTITUTED VIAL)	Medications	140 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Additional Orders
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	every 24 hours	Start: S+1			Instructions:	PREMED FOR ALEMTUZUMAB.		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	every 24 hours	Start: S+1			Instructions:	PREMED for ALEMTUZUMAB.		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	every 24 hours	Start: S+1			Instructions:	PREMED for ALEMTUZUMAB		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses	Start: S+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		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once for 1 dose				Instructions:	Premed for TRANSPLANT			Transplant Orders
  	ONC NURSING COMMUNICATION 55	Interval: Once	Occurrences: --	Comments:	-Oxygen at bedside during transplantation
-Anaphylaxis precautions at bedside during transplant:
		  	morPHINE injection 2 mg	Dose: 2 mg	Route: intravenous	every 30 min PRN for 2 doses	Start: S			Instructions:	If no relief in 30 minutes, may give another dose morphine 2 mg IV X 1 PRN for drug-induced rigors.		  	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	once PRN	Start: S	End: S+2			  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once PRN	Start: S	End: S+2			  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once PRN							Day 1	Perform every 1 day x1		Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron ODT (ZOFRAN-ODT) disintegrating tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours PRN	Start: S+2