Haematology / Page 1 of 5
NHL Mantle cell
R Hyper-CVAD
This alternates with R MTX Ara C / Height / cm
Weight / kg
BSA / M2
Cycle length: / 21 days / CBC / Day 1 / Limits / Allergies/Hypersensitivities:
Antiemetics
± domperidone 10mg PO QID
± cyclizine 50mg PO/IVTDS / Agent
Rituximab on day 1
Cyclophosphamide days 2-4 Q12H
Vincristine days 5 and 12 (2 doses)
Doxorubicin day 5
dexamethasone days 2-5 and 12-15
DOSE MODIFIED:NO YESNOYES / Round
10mg
20mg
0.2mg
5mg
Cycle no / 1 3 5 71 of 83 of 85 of 87 of 8 / Date
Destination / Neuts / > 1 X 109/L
Plts / 75 X 109/L
Reference:Romaguera et al JCO, 2005 23(28) 7013-23
Ritchie et al Ann Hematol 2007 86: 101-105
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
1 / T= -60 mins / Methylprednisone / 100 / mg / IV / In 100ml 0.9% saline over 15 mins
T= -60 mins / Paracetamol / 1000 / mg / PO / 30-60 minutes prior to rituximab
T= -60 mins / Loratidine / 20 / mg / PO / 30-60 minutes prior to rituximab
*Rituxumab 375mg/m2 / mg / IV / Standard infusion: added to 500 ml 0.9S
Rapid infusion: added to 500ml 0.9S
2-5 / Dexamethasonedaily for 4 days / 40 / mg / PO / (days 2-5 and 12-15) Prescribe on QMR4/outpatient script

* See rituximab recording chart, page 4

  • Encourage patients to drink at least 3 litres of fluid per day, and to void frequently when receiving cyclophosphamide.
  • Hyper CVAD consists of 2 regimes – Hyper CVAD and High dose Methotrexate and Cytarabine Arabinoside. A full cycle consists of both regimes given 21 days apart.
  • 4 full cycles are usually given. See Red book for full details of this protocol.

Patient Category:
Y J A P O 1 3 Z / OSP Group:
1 2 3 4 5 6 7 / Consultant:
NZMC Reg. No: / Special Authority Rituximab
NHL Mantle cell:
Hyper-CVAD / Height / cm
Weight / kg
BSA / M2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
2 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T =0 / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml 0.9S over 2 hours Q12H
0.9% Sodium Chloride / 100 / ml / IV / For flushing
Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T +12h / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml 0.9S over 2 hours Q12H
0.9% Sodium Chloride / 100 / ml / IV / For flushing
3 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T =0 / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml 0.9S over 2 hours Q12H
0.9% Sodium Chloride / 100 / ml / IV / For flushing
Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T +12h / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml 0.9S over 2 hours Q12H
0.9% Sodium Chloride / 100 / ml / IV / For flushing
4 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T = 0 / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml 0.9S over 2 hours Q12H
0.9% Sodium Chloride / 100 / ml / IV / For flushing
Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T +12 / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml 0.9S over 2 hours Q12H
0.9% Sodium Chloride / 100 / ml / IV / For flushing
NHL Mantle cell:
Hyper-CVAD / Height / cm
Weight / kg
BSA / m2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
5 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
Vincristine 1.4mg/m2 / mg / IV / In 50ml 0.9S free run over 10 mins
0.9% Sodium Chloride / 250 / ml / IV / Flush and fast running saline
Doxorubicin 50mg/m2 / mg / IV / Slow bolus into fast running 0.9S
Ondansetron / 8 / mg / PO/IV
6-16 / #Filgrastim (G-CSF) 5mcg/kg / 300480 / mcg / SC / Daily, starting at least 24 hrsfollowing chemotherapy
12 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
Vincristine 1.4mg/m2 / mg / IV / In 50ml 0.9S free run over 10 mins
0.9% Sodium Chloride / 100 / ml / IV / For flushing
Ondansetron / 8 / mg / PO/IV
12-15 / Dexamethasone daily for 4 days / 40 / mg / PO / Chart on QMR4 or give OP Script (See above).

# Chart on QMR4 or give outpatient script. Advise patients to stop filgrastim if bony pain develops

Authorised byAndrew ButlerPharmacist: Bevan Harden / February 2015
T:\Pictures\CDHB\Red_Book\NHL Mantle cell R-hyper-CVAD.docx / Review 2016
CHEMOTHERAPY
MEDICATION
CHART

Haematology / Page 1 of 5
Rituximab (Mabthera®) giving instructions
Patient label
Date

Standard infusion:

/ Commence infusion at 50 mg/hr for the first hour, if no side effects; increase the infusion rate in 50mg increments every 30 minutes to a maximum rate of 400mg/hr. Remember that the IV line will have been primed with saline therefore rituximab will not be infused immediately.
To calculate 50mg in _____ml
Rapid infusion: / If no previous toxicities, give 20% of the dose over 30 minutes and the remaining 80% over the following 60 minutes.
If any adverse effects noted: / Discontinue infusion, evaluate severity of symptoms, and treat accordingly. If reactions settle, recommence at ½ the previous rate. Consider hydrocortisone 100mg IV if required, plus chlorphenamine and paracetamol depending on time interval.
Document recordings – T,P,R,B/P and EWS on adult observation chart
Following infusion: Observe for delayed side effects, for 2 hours following infusion.
Time / Rate / Comments
Baseline
30 mins
45 mins
60 mins
75 mins
2 hours
3 hours
4 hours
5 hours

Note:•Monitor patients with high tumour burden for infusion related reactions and tumour lysis syndrome.

•Ensure adequate hydration and consider addition of allopurinol for 1 – 3 courses.

DO NOT SHAKE during preparation, rotate gently. Aggregation & precipitation of antibody can occur.

PRN medications for Hypersensitivity reactions

Date / Time / Medication / Dose / Route / Doctor / Nurse / Check
Hydrocortisone / 100 mg / Slow IV bolus
Paracetamol / 1000 mg / PO
Chlorphenamine / 10 mg / Slow IV bolus
PRN antiemetics / DR / NURSE SIGN
Domperidone / 10-20 mg / PO QID
Cyclizine / 50 mg / PO/IV Q8H
Lorazepam / 0.5-1 mg / PO BD
Authorised by Andrew ButlerPharmacist: Bevan Harden / February 2015
T:\Pictures\CDHB\Red_Book\NHL Mantle cell R-hyper-CVAD.docx / Review 2016