Chemotherapy Chart Burkitt-Type Lymphoma R Hyper C VAD Cycles 1 and 3

Haematology / Page 1 of 5
Burkitt-type Lymphoma
Hyper-CVAD
This alternates with MTX Ara C / Height / cm
Weight / kg
BSA / m2
Cycle length: / 21 days / CBC / Day 1 / Limits / Allergies/Hypersensitivities:
Antiemetics
± domperidone 10-20mg PO QID
± Lorazepam 1-2mg PO daily / Agent
Rituximab days 1 and 11 for 1st4 cycles
Cyclophosphamide days 1-4 Q12H
Vincristine days 4 and 11 (2 doses)
Doxorubicin day 4
Dexamethasone days 1-4 and 11-14
DOSE MODIFIED:NO YESNOYES / Round
10 mg
20mg
0.2mg
5mg
Cycle no / 1 3 / Date
Destination / Neuts / ≥3 X 109/L
Plts / ≥50X 109/L
Reference:Thomas et al Cancer, 2006106(7) 1569-1580
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
-1 / Methotrexate 12mg IT / See intrathecal chemotherapy chart
1 / *Methylprednisone / 100 / mg / IV / In 100ml 0.9% saline over 15 mins
*Paracetamol / 1000 / mg / PO / 30-60 minutes prior to rituximab
*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
1-4 / Dexamethasone daily for 4 days / 40 / mg / PO / (days 1-4 and 11-14) Prescribe on QMR4/outpatient script
1 / Ondansetron / 8 / mg / PO / Give 30-60 minutes prior to chemo
T =0 / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml D5W over 2 hours Q12H
T =0 / MESNA 600mg/m2 / mg / IV / In 500ml D5W over 24 hrs

* Rituximab is given for the first 4 cycles only– 8 doses. See rituximab recording chart Page 4

Give IV hydration with alkalinisation and allopuinol ( or rasbuicase for high tumour burden) during course 1. Encourage patients to drink at least 3 litres of fluid per day, and to void frequently when receiving cyclophosphamide.Cyclophosphamide and mesna are infused via a Y-site connector
Hyper CVAD consists of 2 regimes – Hyper CVAD and High dose Methotrexate and Cytarabine Arabinoside. Both regimes are given 21 days apart.8 cycles are usually given.
CNS prophylaxis is given with each cycle total of 16 treatments. If CNS disease, IT therapy is given twice weekly until CSF cell count normalised and cytology negative.

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
Burkitt-type Lymphoma
Hyper-CVAD
This alternates with MTX Ara C / Height / cm
Weight / kg
BSA / m2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
1 / Ondansetron / 8 / mg / PO / Give 30-60 minutes prior to chemo
T +12h / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml D5Wover 2 hours Q12H
2 / Ondansetron / 8 / mg / PO / Give 30-60 minutes prior to chemo
T =0 / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml D5W over 2 hours Q12H
T =0 / MESNA 600mg/m2 / mg / IV / In 1000ml D5W over 24 hrs
Ondansetron / 8 / mg / PO / Give 30-60 minutes prior to chemo
T +12h / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml D5W over 2 hours Q12H
3 / Ondansetron / 8 / mg / PO / Give 30-60 minutes prior to chemo
T =0 / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml D5W over 2 hours Q12H
T =0 / MESNA 600mg/m2 / mg / IV / In 1000ml D5W over 24 hrs
Ondansetron / 8 / mg / PO / Give 30-60 minutes prior to chemo
T +12h / Cyclophosphamide 300mg/m2 / mg / IV / In 100ml D5W over 2 hours Q12H
4 / 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 / In 500ml 0.9% saline over 24 hrs
Pegylated G-CSF / 6 / mg / SC / 24 hours following last dose of chemotherapy.

Doxorubicin must be given via a CVAD

Burkitt-type Lymphoma
Hyper-CVAD
This alternates with MTX Ara C / Height / cm
Weight / kg
BSA / m2
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
8 / Cytarabine 100mg IT / See intrathecal chemotherapy chart
11 / *Methylprednisone / 100 / mg / IV / In 100ml 0.9% saline over 15 mins
*Paracetamol / 1000 / mg / PO / 30-60 minutes prior to rituximab
*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
11 / Vincristine 1.4mg/m2 / mg / IV / In 50ml 0.9S free run over 10 mins
0.9% Sodium Chloride / 100 / ml / IV / For flushing
11-14 / Dexamethasone daily for 4 days / 40 / mg / PO / Chart on QMR4 or give OP Script

* Rituximab is given for the first 4 cycles only– 8 doses. See rituximab recording chart Page 5

Authorised by Dr S Gibbons Pharmacist: B Harden / February 2015
T:\Pictures\CDHB\Red_Book\NHL Burkitt-type lymphoma Ritux hyper-CVAD cycles 1 and 3.docx / Review: 2016
CHEMOTHERAPY
MEDICATION
CHART
C260070

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

Standard infusion:

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 Dr S GibbonsPharmacist B Harden / February 2015
T:\Pictures\CDHB\Red_Book\NHL Burkitt-type lymphoma Ritux hyper-CVAD cycles 1 and 3.docx / Review 2016