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IP COHORT A: FLU / BU + CONTROL BMT CTN 2203	

Types:      Research Oncology Treatment
Synonyms:  FLU, BU

Transplant	Repeat 1 time	Cycle length: 86 days	Days -6 through -1	Perform every 1 day x1			Research tolerance: -0/+0 days	Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: Once	Occurrences: --	Comments:	It is recommended that adjusted ideal body weight be used when calculating conditioning regimen chemotherapy doses (AIBW = IBW + [(0.25) x (ABW* - IBW)])
			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					Additional Orders
  	ONC NURSING COMMUNICATION 49	Interval: Until discontinued	Occurrences: --	Comments:	Do NOT administer Acetaminophen/Azoles for 48 hours after last busulfan dose.
			Pre-Medications
  	ondansetron (ZOFRAN) 16 mg, dexAMETHasone (DECADRON) 12 mg in sodium chloride 0.9% 50 mL IVPB	Dose: 16 mg	Route: intravenous	every 24 hours over 10 Minutes for 3 doses	Start: S			Instructions:	Administer 30 minutes prior to treatment on Day -6, -5, -4.	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	12 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			  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S+1  7:30 AM			Instructions:	Administer 30 minutes prior to treatment on Day -5		  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	every 24 hours for 2 doses	Start: S+3  7:30 AM			Instructions:	Administer on Day -3, -2.			Antiemetics
  	prochlorperazine edisylate injection 5 mg	Dose: 5 mg	Route: intravenous	every 4 hours PRN	Start: S					Supportive Care
  	valACYclovir (VALTREX) tablet 500 mg	Dose: 500 mg	Route: oral	daily	Start: S				  	levoFLOXacin (LEVAQUIN) tablet 500 mg	Dose: 500 mg	Route: oral	daily at 0600 (TIME CRITICAL) for 56 doses	Start: S				  	micafungin (MYCAMINE) IVPB (RESTRICTED) 100 mg	Dose: 100 mg	Route: intravenous	every 24 hours over 1 Hours for 11 doses	Start: S					Chemotherapy
  	busulfan (BUSULFEX) 0.8 mg/kg in sodium chloride 0.9% chemo IVPB	Dose: 0.8 mg/kg	Route: intravenous	every 6 hours over 2 Hours for 8 doses	Start: S+1  8:00 AM			Instructions:	Day -5, -4	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	BUSULFAN 60 MG/10 ML INTRAVENOUS SOLUTION	Medications	0.8 mg/kg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	 	Yes	Yes			  	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			Offset: 30 Minutes	Instructions:	Start 30 minutes after treatment start time: Day -6, -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				Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN						Seizure Prophylaxis
  	levETIRAcetam (KEPPRA) tablet 750 mg	Dose: 750 mg	Route: oral	2 times daily for 9 doses	Start: S  9:00 PM			Instructions:	continue for 48 hours post completion of busulfan			VOD Prophylaxis
  	ursodioL (ACTIGALL) capsule 300 mg	Dose: 300 mg	Route: oral	3 times daily						Day of Rest
  	ONC NURSING COMMUNICATION 48	Interval: Until discontinued	Occurrences: --	Comments:	Day -1.
				Day 0	Perform every 1 day x1			Research tolerance: -0/+0 days	Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: Until discontinued	Occurrences: --	Comments:	No steroids should be given from Day 0 until 24 hours after the completion of the post-transplant cyclophosphamide (Day +5); including corticosteroids as anti-emetics
			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:
		  	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							Days 1 through 8	Perform every 1 day x1			Research tolerance: -0/+0 days	Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	ondansetron (ZOFRAN) IV 16 mg	Dose: 16 mg	Route: intravenous	every 24 hours for 5 doses	Start: S  8:00 AM			Instructions:	Administer on Days +1 through +5		  	fosaprepitant (EMEND) IVPB 150 mg	Dose: 150 mg	Route: intravenous	once over 30 Minutes for 1 dose	Start: S+2  8:00 AM			Instructions:	Administer 30 minutes prior to treatment on Day +3.		  	ondansetron (ZOFRAN) IV 8 mg	Dose: 8 mg	Route: intravenous	every 8 hours PRN	Start: S+5			Instructions:	Start Day +6			Nursing Orders
  	ECG 12-LEAD	Interval: Daily	Occurrences: --	Comments:	Starting Day +3. Must be reviewed by MD daily prior to each Cyclophosphamide dose.
			Labs
  	URINALYSIS, AUTOMATED WITH MICROSCOPY	Interval: Daily	Occurrences: --	Comments:	Start Day +3
			Chemotherapy
  	ONC NURSING COMMUNICATION 7	Interval: Until discontinued	Occurrences: --	Comments:	During CYCLOPHOSPHAMIDE:
o 12 lead EKG must be ordered and reviewed by physician prior to each dose. 
o 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). 
o Instruct patient to void every 1-2 hours DAILY x 3 days.
		  	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	Start: S+2  8:30 AM			Instructions:	Give immediately prior to first cyclophosphamide infusion	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 2 doses	Start: S+2  9:00 AM			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 for 12 doses	Start: S+2  1:00 PM			Instructions:	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				Hydration
  	sodium chloride 0.9 % infusion	Dose: 125 mL/hr	Route: intravenous	continuous	Start: S+2  4:00 AM					Additional Orders
  	furosemide (LASIX) injection 20 mg	Dose: 20 mg	Route: intravenous	every 24 hours for 2 doses	Start: S+2 11:00 AM			Instructions:	Give at completion of each dose of cyclophosphamide infusion on Day +3 and Day +4 .		  	furosemide (LASIX) injection 20 mg	Dose: 20 mg	Route: intravenous	every 24 hours for 2 doses	Start: S+2  5:00 PM			Instructions:	Give 6 hours AFTER completion of each dose of Cyclophosphamide infusion on Day +3 and Day +4			Supportive Care
  	posaconazole (NOXAFIL) tablet (RESTRICTED) 300 mg	Dose: 300 mg	Route: oral	every 24 hours	Start: S+4  9:00 AM			Instructions:	Start Day +5. 
Do NOT crush, split, or chew.  The delayed release tablet is NOT to interchange / substitute with oral posaconazole suspension.		  	tbo-filgrastim (GRANIX) injection solution	Dose: --	Route: subcutaneous	daily at 1600	Start: S+6  4:00 PM			Instructions:	Start Day +7. 
Do not administer tbo-filgrastim within 24 hours before chemotherapy.	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			Acute Graft Versus Host Prophylaxis
  	ONC NURSING COMMUNICATION	Interval: Until discontinued	Occurrences: --	Comments:	If patient is CMV positive and will be on posaconazole, then the dose of tacrolimus should be reduced to 0.015 mg/kg
		  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S+4  4:00 PM			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).		  	mycophenolate (CELLCEPT) 1,000 mg in dextrose 5% IVPB	Dose: 1,000 mg	Route: intravenous	Every 8 Hours (TIME CRITICAL)  over 2 Hours	Start: S+4  8:00 AM			Instructions:	Start Day +5	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	MYCOPHENOLATE 500 MG/15 ML INTRAVENOUS SOLUTION (RECONSTITUTED VIAL)	Medications	1,000 mg	Main Ingredient	No	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	167 mL	Always	Yes