Haematology / Page 1 of 6
NHL Mantle cell lymphoma
R- MTX Ara C / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Cycle length: / 21 days / CBC / Day 1 / Limits / Allergies/hypersensitivities
Antiemetics
± cyclizine 50mg PO/IVTDS / Agent
Rituximab day 1
Methotrexate day 2 (over 24 hrs)
Cytarabine Q12H days 3 and4
Steroid eye drops
Folinic acid
DOSE MODIFIED:NO YESNoYes / Round
10mg
100mg
100mg
Cycle no / 2 4 6 82 of 84 of 86 of 88 of 8 / Date
Destination / BMTUHDWONC OPWD 27 / Neuts / > 1 X 109/L
Plts / > 50 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 / Rate / Doctor / Nurse / Check / Start / Stop
1 / T= -1 hr / Methylprednisolone / 100 / mg / IV / In 100ml 0.9% saline over 15 mins
T= -1 hr / Paracetamol / 1000 / mg / PO / 30-60 minutes prior to rituximab
T= -1 hr / 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
2200 / Ural Sachet® / 1 / PO / Dissolved in 20mL water
2 / t-5 hr / 0400 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
Dexamethasone / 8 / mg / PO / 30-60 minutes prior to chemo
  • IV fluids run concurrently with chemotherapy, continue for 48 hours from the start of the MTX infusion.
  • Calculate the rate of infusion based on patient surface area and prescribe in the rates column. Modify rate if there is evidence of overload, consider frusemide
  • Urine pH must be > 7.5 before starting methotrexate. Adjust NaHCO3 to keep pH between 7 and 8.
  • Chart prednisolone eye drops QID from days 2-8
  • Stop proton pump inhibitor the day prior to MTX infusion. Restart once MTX has cleared.

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 lymphoma
R- MTX Ara C / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
2 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
T = 0
0900 / Methotrexate 200mg/m2 / mg / IV / 250ml 0.9% S over 2 hrs / 125ml/hr
1100 / Methotrexate 800mg/m2 / mg / IV / 1000ml 0.9% S over 22 hrs / 46 ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
Ondansetron / 8 / mg / PO/IV
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
3 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr
Dexamethasone / 8 / mg / PO / 30-60 minutes prior to chemo
Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T =+240900 / Stop Methotrexate transfusion
0900 / Cytarabine 3000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
NHL Mantle cell lymphoma
R- MTX Ara C / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
3 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
T =+36hr
2100 / Folinic acid / 50 / mg / IV / Slow bolus 36 hrs after start of MTX
2100 / Cytarabine 3000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
4 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0300 / Folinic acid / 15 / mg / PO
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
Dexamethasone / 8 / mg / PO / 30-60 minutes prior to chemo
Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid / 15 / mg / PO
0900 / Cytarabine 3000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
1500 / Folinic acid / 15 / mg / PO
Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
2100 / Folinic acid / 15 / mg / PO
2100 / Cytarabine 3000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
NHL Mantle cell lymphoma
R- MTX Ara C / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
5 / 0300 / Folinic acid / 15 / mg / PO
Dexamethasone / 8 / mg / PO
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. CHART ON QMR4. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid / 15 / mg / PO
2100 / Pegylated GCSF / 6 / mg / SC / 24 hours after cytarabine
6 / Dexamethasone / 8 / mg / PO
Authorised by Andrew ButlerPharmacist Bevan Harden / Updated: February 2015
T:\Pictures\CDHB\Red_Book\NHL Mantle Cell R MTX cytarabine.docx / Review:2016

Haematology / Page 1 of 6
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 50 mg increments every 30 minutes to a maximum rate of 400 mg/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 100 mg 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 / Updated: February 2015
T:\Pictures\CDHB\Red_Book\NHL Mantle Cell R MTX cytarabine.docx / Review 2016