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IP CAGT AUTOLOGOUS SCT HIGH DOSE MELPHALAN	

Types:      ONCOLOGY TREATMENT
Synonyms:  MELPHALAN, ALKERAN, MELP, ALK, BMT, CAGT, AUTOLOGOUS, SCT

Transplant	Repeat 1 time	Cycle length: 90 days	Days -2 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).
			Provider Communication
  	ONC PROVIDER COMMUNICATION 28	Interval: --	Occurrences: --	Comments:	Okay to change medications to either IV or ODT formulation if patient is unable to tolerate oral.
			Nursing Orders
  	ONC NURSING COMMUNICATION 22	Interval: Once	Occurrences: --	Comments:	Provide ice chips and / or popsicles to patient 30 minutes prior, during and for 30 minutes following Melphalan infusion.
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	fosaprepitant (EMEND) 150 mg in sodium chloride 0.9% 150 mL IVPB	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S			Instructions:	Administer 1 hour prior to melphalan on Day -2.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	FOSAPREPITANT 150 MG INTRAVENOUS POWDER FOR SOLUTION	Medications	150 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	145 mL	Yes	Yes			  	OLANZapine (ZYPREXA) tablet 5 mg	Dose: 5 mg	Route: oral	daily for 4 doses	Start: S  8:00 AM				  	ondansetron (ZOFRAN) tablet 16 mg	Dose: 16 mg	Route: oral	once for 1 dose	Start: S  8:00 AM				  	dexAMETHasone (DECADRON) tablet 12 mg	Dose: 12 mg	Route: oral	once for 1 dose	Start: S  8:00 AM				  	ondansetron (ZOFRAN) tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours	Start: S+1  9:00 AM					Supportive Care
  	fluconazole (DIFLUCAN) tablet 200 mg	Dose: 200 mg	Route: oral	daily	Start: S				  	acyclovir (ZOVIRAX) tablet 400 mg	Dose: 400 mg	Route: oral	2 times daily	Start: S				  	levoFLOXacin (LEVAQUIN) tablet 500 mg	Dose: 500 mg	Route: oral	daily at 0600 (TIME CRITICAL)	Start: S+3			Instructions:	Starting on Day +1.			Supportive Care
  	tbo-filgrastim (GRANIX) injection solution	Dose: --	Route: subcutaneous	daily at 1600	Start: S+9			Instructions:	Do not administer tbo-filgrastim within 24 hours before chemotherapy.
Start Day +7.	Rule-Based Template: RULE ONCBCN NEUPOGEN WEIGHT BASED	  Conditions:	  Modifications:	  Weight > 78 kg	  Set dose to 480 mcg	  Weight <= 78 kg	  Set dose to 300 mcg			Antiemetics
  	prochlorperazine (COMPAZINE) injection 5 mg	Dose: 5 mg	Route: intravenous	every 6 hours PRN	Start: S					Chemotherapy
  	melphalan HCL (ALKERAN) 200 mg/m2 in sodium chloride 0.9% 250 mL chemo IVPB	Dose: 200 mg/m2	Route: intravenous	once over 15 Minutes for 1 dose	Start: S  9:00 AM	End: S		Instructions:	Day -2.

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	200 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	250 mL	Yes	Yes				Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN							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:	- Give morphine 2 mg IV X 1 PRN drug-induced rigors. If no relief in 30 minutes, may give another dose of 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			Instructions:	Start Day +3