Download Chemotherapy chart UKALL 14 Induction 1

Canterbury Regional Cancer and Blood Service (Haematology)
Page 1 of 3
UKALL 14
Induction Phase 1
Day 1
Height
cm
Weight
kg
BSA
m2
Cycle length:
28 days
CBC
Date
Limits
Destination:
BMTU
Hb
Antiemetics
Neuts
Domperidone 10 mg PO QID
± Cyclizine 50 mg PO/IV TDS
Hypersensitivities/Allergies
Plts
Reference: UKALL 14 trial protocol –v5.0 – 20/07/12
Day Date
Time
-7 to -1
Agent
Dose
Route
Instructions
Doctor Nurse Check Start Stop
Dexamethasone 6 mg/m2/day
mg
PO
Prescribe on regular medication chart (pre-phase for 5-7 days)
Dexamethasone 10 mg/m2
(max 20 mg)
mg
PO
Prescribe once daily in the morning on regular medication chart
mg
PO
Patients with Philadelphia positive disease should also receive continuous daily Imatinib,
PO, starting at 400mg, aiming to escalate to 600mg within 2 weeks, if tolerated. This should
be continued until transplant wherever possible. Prescribe on regular medication chart.
Continuous from
day 1
Imatinib
1
Ondansetron
Daunorubicin 30 mg/m2
8
mg
mg
PO/IV
IV
*Sodium chloride 0.9 %
250
mL
IV
mg
IV
mg
PO/IV
(Philadelphia +ve patients only)
Vincristine 1.4 mg/m2 (max 2mg)
Ondansetron



Round
5 mg
0.2 mg
75 units (IU)
DOSE MODIFIED: Yes / No
(Steroid pre-phase)
Days 1-4, 8-11, 15-18
Agent
Daunorubicin
Vincristine
Peg-Asparaginase
8
Give one hour prior to chemotherapy
In 100 mL sodium chloride 0.9 % over
20 minutes (via side arm of fast running
sodium chloride 0.9 % if peripheral)
In 50 mL sodium chloride 0.9 % free run
over 10 minutes
* Sodium chloride 0.9 % not required for central line administration of daunorubicin
Daunorubicin should be infused through a CVAD. Free flow (DO NOT PUMP) if given peripherally
Azole antifungals should not be given within 72 hours of vincristine (i.e. not in this cycle)
Consultant:
NZMC Reg. No:
Authorised by: Dr P Ganly
Pharmacists: C Innes / B Harden
Special authority:
Peg-Asparaginase
August 2012
Review August 2013, April 2016
Canterbury Regional Cancer and Blood Service (Haematology)
UKALL 14
Induction Phase 1
Day Date
Time
Height
cm
Weight
kg
BSA
m2
Agent
#
4
Page 2 of 3
Dose
Peg-Asparaginase 1000 units/m2
units
(Philadelphia –ve patients ≤ 40 years only)
8
Route
Ondansetron
Daunorubicin 30 mg/m2
8
*Sodium chloride 0.9 %
250
mg PO/IV
mg
IV
mL
Vincristine 1.4 mg/m2 (max 2mg)
IV
IV
Ondansetron
8
14
Methotrexate 12 mg
15
Ondansetron
Daunorubicin 30 mg/m2
8
*Sodium chloride 0.9 %
250
Ondansetron
8
Check
Start
Stop
Give one hour prior to chemotherapy
In 100 mL sodium chloride 0.9 % over 20
minutes (via side arm of fast running
sodium chloride 0.9 % if peripheral)
In 50 mL sodium chloride 0.9 % free run
over 10 minutes
mg PO/IV
IT
Vincristine 1.4 mg/m2 (max 2mg)







IV
Instructions
Doctor Nurse
In 100 mL sodium chloride 0.9 % over at
least 1 hour
mg PO/IV
mg
IV
mL
IV
mg
IV
See separate intrathecal chemotherapy medication chart (C160016)
Give one hour prior to chemotherapy
In 100 mL sodium chloride 0.9 % over 20
minutes (via side arm of fast running
sodium chloride 0.9 % if peripheral)
In 50 mL sodium chloride 0.9 % free run
over 10 minutes
mg PO/IV
* Sodium chloride 0.9 % not required for central line administration of daunorubicin
Daunorubicin should be infused through a CVAD. Free flow (DO NOT PUMP) if given peripherally
#
Philadelphia positive patients should not be given Peg-Asparaginase in Induction
#
Omit day 4 Peg-Asparaginase for Philadelphia negative patients OVER 40 years. These patients should only receive day 18 Peg-Asparaginase.
Check Antithrombin III and Fibrinogen every 2 days while receiving Peg-Asparaginase
Diagnostic LP and IT Methotrexate is given on day 14 (unless there are clinical signs of CNS involvement, in which case the LP is performed earlier)
Timing of intrathecal therapy can be moved +/- 3 days to allow administration on specific lists as per local and national guidance
Authorised by: Dr P Ganly
Pharmacists: C Innes / B Harden
August 2012
Review August 2013, April 2016
Canterbury Regional Cancer and Blood Service (Haematology)
UKALL 14
Induction Phase 1
Day Date
Time
Height
cm
Weight
kg
BSA
m2
Agent
#
18
Page 3 of 3
Dose
Peg-Asparaginase 1000 units/m2
units
(Philadelphia –ve patients only)
22
Ondansetron
Daunorubicin 30 mg/m2
8
*Sodium chloride 0.9 %
250
Vincristine 1.4 mg/m2 (max 2mg)
Ondansetron
Filgrastim
23





Route
8
300
IV
mg PO/IV
mg
IV
mL
IV
mg
IV
mg PO/IV
mcg subcut
Instructions
Doctor Nurse
In 100 mL sodium chloride 0.9 % over at
least 1 hour
Check
Start
Stop
Give one hour prior to chemotherapy
In 100 mL sodium chloride 0.9 % over 20
minutes (via side arm of fast running
sodium chloride 0.9 % if peripheral)
In 50 mL sodium chloride 0.9 % free run
over 10 minutes
Once daily until count recovery (prescribe on regular medication chart)
* Sodium chloride 0.9 % not required for central line administration of daunorubicin
Daunorubicin should be infused through a CVAD. Free flow (DO NOT PUMP) if given peripherally
#
Philadelphia positive patients should not be given Peg-Asparaginase in Induction
Check Antithrombin III and Fibrinogen every 2 days while receiving Peg-Asparaginase
Commence Induction 2 once platelets are >75 X 109/L and neutrophils > 0.75 X 109/L
Authorised by: Dr P Ganly
Pharmacists: C Innes / B Harden
August 2012
Review August 2013, April 2016