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IP COHORT B: FLU / BU + INVESTIGATIONAL BMT CTN 2203	

Types:      Research Oncology Treatment
Synonyms:  FLU, BU

Transplant	Repeat 1 time	Cycle length: 90 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 Days -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 30 minutes prior to treatment on Days -3, -2.			Antiemetics
☑	prochlorperazine (COMPAZINE) 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) 100 mg in sodium chloride 0.9% 100 mL IVPB	Dose: 100 mg	Route: intravenous	every 24 hours over 1 Hours for 12 doses	Start: S			Ingredients:	Name	Type	Dose	Selected	Adds Vol.	MICAFUNGIN 100 MG INTRAVENOUS SOLUTION (RESTRICTED)	Medications	100 mg	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	100 mL	Yes	Yes				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			Instructions:	continue for 48 hours post completion of busulfan 			VOD Prophylaxis
  	ursodiol (ACTIGALL) capsule 300 mg	Dose: 300 mg	Route: oral	3 times daily	Start: S					Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: Until discontinued	Occurrences: --	Comments:	Ruxolitinib will be dispensed from IDS pharmacy via a paper order.
			Acute Graft Versus Host Prophylaxis
  	ONC NURSING COMMUNICATION 83	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+3  4:00 PM			Instructions:	Start on Day -3.  May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).			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					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 11	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					Antiemetics
  	ondansetron ODT (ZOFRAN-ODT) disintegrating tablet 8 mg	Dose: 8 mg	Route: oral	every 8 hours PRN				Instructions:	Start day +1			Acute Graft Versus Host Prophylaxis
  	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 11:00 AM			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 11:00 AM			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				Medications
  	tbo-filgrastim (GRANIX) injection syringe 480 mcg	Dose: 480 mcg	Route: subcutaneous	daily at 1600	Start: S+6  4:00 PM			Instructions:	Do not administer tbo-filgrastim within 24 hours before chemotherapy. 
Start on D+7			Supportive Care
  	posaconazole (NOXAFIL) tablet (RESTRICTED) 300 mg	Dose: 300 mg	Route: oral	daily	Start: S+4			Instructions:	Start on day +5