Haematology / Page 1 of 6
NHL: Burkitt Lymphoma
R- IVAC for patients over 65 years / Height / cm
Weight / kg
BSA / m2
Cycle length: / CBC / Day 1 / Limits / Hypersensitivities/Allergies
Antiemetics
Domperidone 10 mg PO QID
Cyclizine 25 mg – 50 mg PO/IV TDS / Agent
Rituximab
Etoposide
Ifosfamide
Mesna
Cytarabine
DOSE MODIFIED:NO YESNoYes / Round
50mg
20mg
50mg
100mg
100mg
Cycle no: / 2 or 4 / Date
Destination: / BMTU / Hb
Neuts / 1.0 X 109/L
Plts / 75 X 109/L
Reference:based on Mead et al Blood 2008; 12(6) 2248-2260
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
1 / T = - 1 hr / # Methylprednisolone / 100 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = - 1 hr / Paracetamol / 1000 / mg / PO / Give 30-60 minutes prior to rituximab
T = - 1 hr / Loratadine / 20 / mg / PO / Give 30-60 minutes prior to rituximab
T = 0 hr / *Rituximab 375 mg/m2 / mg / IV / Standard infusion: added to 500 mL sodium chloride 0.9 %
Rapid infusion: added to 500 mL sodium chloride 0.9 %
2 / Ondansetron / 8 / mg / PO/IV / Give 1 hour prior to chemotherapy.
If giving IV dexamethasone, infuse in 100 mL sodium chloride 0.9 % over 10-15 minutes
Dexamethasone / 8 / mg / PO/IV
T = -1 hrs / Etoposide 60 mg/m2 / mg / IV / In 500 mL sodium chloride 0.9 % over 1 hour

See rituximab infusion chart page 6

  • If no reaction to the first dose of rituximab, methylprednisolone may be omitted at the prescribers discretion
  • This regimen alternates with CODOX-M
  • Dipstick urine with each void to check for haematuria. Patients must void 150 mL/hr while receiving Ifosfamide. Encourage patients to void 2 hourly.
  • On Medchart prescribe prednisolone eye drops 1 % TDS starting 12 hours before cytarabine and continuing for 5 days after completion.

Consultant:
NZMC Reg. No: / Special Authority Rituximab
NHL: Burkitt Lymphoma
R- IVAC for patients over 65 years / Height / cm
Weight / kg
BSA / m2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
2 / T = 0 hrs / Ifosfamide 1000 mg/m2 / mg / IV / Mixed together in 500 mL sodium chloride 0.9% and given over 1 hour
Mesna 200 mg/m2 / mg / IV
T = +1 hrs / Cytarabine 1000 mg/m2(q12h) / mg / IV / In 1000 mL sodium chloride 0.9 % over 3 hours
T = +4 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +8 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +12 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T =+13 hrs / Cytarabine 1000 mg/m2(q12h) / mg / IV / In 1000 mL sodium chloride 0.9 % over 3 hours
T = +16 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
2000 / Ondansetron / 8 / mg / PO/IV
3 / Ondansetron / 8 / mg / PO/IV / Give 1 hour prior to chemotherapy.
If giving IV dexamethasone, infuse in 100 mL sodium chloride 0.9 % over 10-15 minutes
Dexamethasone / 8 / mg / PO/IV
T = -1 hrs / Etoposide 60 mg/m2 / mg / IV / In 500 mL sodium chloride 0.9 % over 1 hour
T = 0 hrs / Ifosfamide 1000 mg/ m2 / mg / IV / Mixed together in 500 mL sodium chloride 0.9% and given over 1 hour
Mesna 200 mg/m2 / mg / IV
T = +1 hrs / Cytarabine 1000 mg/m2(q12h) / mg / IV / In 1000 mL sodium chloride 0.9 % over 3 hours
T = +4 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
  • On Medchart prescribe prednisolone eye drops 1 % TDS starting 12 hours before cytarabine and continuing for 5 days after completion.

NHL: Burkitt Lymphoma
R- IVAC for patients over 65 years / Height / cm
Weight / kg
BSA / m2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
3 / T = +8 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +12 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +13 hrs / Cytarabine 1000 mg/m2(q12h) / mg / IV / In 1000 mL sodium chloride 0.9 % over 3 hours
T = +16 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
2000 / Ondansetron / 8 / mg / PO/IV
4 / Ondansetron / 8 / mg / PO/IV / Give 1 hour prior to chemotherapy.
If giving IV dexamethasone, infuse in 100 mL sodium chloride 0.9 % over 10-15 minutes
Dexamethasone / 8 / mg / PO/IV
T = -1 hrs / Etoposide 60 mg/m2 / mg / IV / In 500 mL sodium chloride 0.9 % over 1 hour
T = 0 hrs / Ifosfamide 1000 mg/m2 / mg / IV / Mixed together in 500 mL sodium chloride 0.9% and given over 1 hour
Mesna 200 mg/m2 / mg / IV
T = +4 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +8 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +12 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +16 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
2000 / Ondansetron / 8 / mg / PO/IV
  • On Medchart prescribe prednisolone eye drops 1 % TDS starting 12 hours before cytarabine and continuing for 5 days after completion.

NHL: Burkitt Lymphoma
R- IVAC for patients over 65 years / Height / cm
Weight / kg
BSA / m2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
5 / Ondansetron / 8 / mg / PO/IV / Give 1 hour prior to chemotherapy.
If giving IV dexamethasone, infuse in 100 mL sodium chloride 0.9 % over 10-15 minutes
Dexamethasone / 8 / mg / PO/IV
T = -1 hrs / Etoposide 60 mg/m2 / mg / IV / In 500 mL sodium chloride 0.9 % over 1 hour
T = 0 hrs / Ifosfamide 1000 mg/m2 / mg / IV / Mixed together in 500 mL sodium chloride 0.9% and given over 1 hour
Mesna 200 mg/m2 / mg / IV
T = +4 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +8 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +12 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +16 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
2000 / Ondansetron / 8 / mg / PO/IV
6 / Methotrexate 12 mg IT / IT / See separate intrathecal chemotherapy medication chart (C160016)
Ondansetron / 8 / mg / PO/IV / Give 1 hour prior to chemotherapy.
If giving IV dexamethasone, infuse in 100 mL sodium chloride 0.9 % over 10-15 minutes
Dexamethasone / 8 / mg / PO/IV
T = -1 hrs / Etoposide 60 mg/m2 / mg / IV / In 500 mL sodium chloride 0.9 % over 1 hour
T = 0 hrs / Ifosfamide 1000 mg/m2 / mg / IV / Mixed together in 500 mL sodium chloride 0.9% and given over 1 hour
Mesna 200 mg/m2 / mg / IV
  • There are strict controls on IT chemotherapy within the CDHB. For advice please call the Haematology pharmacist (pager 8209)

NHL: Burkitt Lymphoma
R- IVAC for patients over 65 years / Height / cm
Weight / kg
BSA / m2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
6 / T = +4 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +8 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +12 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
T = +16 hrs / Mesna 200 mg/m2 / mg / IV / In 100 mL sodium chloride 0.9 % over 15 minutes
2000 / Ondansetron / 8 / mg / PO/IV
7 / 0800 / Ondansetron / 8 / mg / PO
0800 / Dexamethasone / 8 / mg / PO
Folinic acid / 15 / mg / PO / 24 hours following intrathecal methotrexate
Pegfilgrastim / 6 / mg / SC / Give at least 24 hours following last dose of chemotherapy
2000 / Ondansetron / 8 / mg / PO
8 / 0800 / Ondansetron / 8 / mg / PO
0800 / Dexamethasone / 8 / mg / PO
2000 / Ondansetron / 8 / mg / PO
  • There are strict controls on IT chemotherapy within the CDHB. For advice please call the Haematology pharmacist (pager 8209)

Authorised by: Dr P GanlyPharmacists: B Harden / C Innes / F Stone / Updated Feb 2015, Jul 2017
Review: 2018
CHEMOTHERAPY
MEDICATION
CHART
C260070

Haematology / Page 1 of 6
Rituximab (Mabthera®) 375 mg/m2giving 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 50 mg 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.
Recordings: / Document T, P, R, B/P and EWS on adult observation chart (C280010) at baseline, 30 minutes, 60 minutes, and hourly thereafter (more frequently if patient is reacting).
Following infusion: Observe for delayed side effects, for 1 hour following 1st infusion. If patient has reacted, observe following subsequent infusion also.
Time / Rate / Comments
Baseline

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 mg / PO QID
Cyclizine / 50 mg / PO/IV Q8H
Lorazepam / 0.5-1 mg / PO BD
Authorised by: Dr P GanlyPharmacist: B Harden / C Innes / Updated: Feb 2015, May 2016
Review: 2017