CANTERBURY DHB (HAEMATOLOGY DEPARTMENT)

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AML – relapsed or refractory protocol – IDA-ARA C

/ DELIVER TO: HDWBMTU
Patient Category:
Y J A P O 1 3 Z / OSP Group:
1 2 3 4 5 6 7 / Doctors Name:
NZMC Reg. No.: / Special Authority Number:
Antiemetics
Ondansetron 8mg PO Q12H
Metoclopramide 20mg PO/IV Q6H / Weight kg / Height cm
BSA m2
Dose Modified / NoYes
ADMINISTRATION USE
DAY / DATE / TIME / CHEMOTHERAPY AGENT / DOSE / ROUTE / INSTRUCTIONS / DR SIGN / GIVEN BY / CHECK / TIME
1 / Idarubicin 12mg/m2 / mg / IV / Bolus into fast running 0.9S
T=0 hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
T+12hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
2 / Idarubicin 12mg/m2 / mg / IV / Bolus into fast running 0.9S
T=0 hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
T+12hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
3 / Idarubicin 12mg/m2 / mg / IV / Bolus into fast running 0.9S
T=0 hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
T+12hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs

Chemotherapy rounding: Cytarabine < 200mg 10mg, 200 – 1000mg 20mg, >1000mg 100mg, Idarubicin 1mg

Note: Chart prednisolone eyedrops 1% starting 12 hours before cytarabine and continue for 5 days after completion. Chart on QMR4

AML – relapsed or refractory protocol – IDA / ARA C / DELIVER TO: HDWBMTU
Patient Category:
Y J A P O 1 3 Z / OSP Group:
1 2 3 4 5 6 7 / Doctors Name:
NZMC Reg. No.: / Special Authority Number:
Antiemetics
Ondansetron 8mg PO Q12H
Metoclopramide 20mg PO/IV Q6H / Weight kg / Height cm
BSA m2
Dose Modified / NoYes
ADMINISTRATION USE
DAY / DATE / TIME / CHEMOTHERAPY AGENT / DOSE / ROUTE / INSTRUCTIONS / DR SIGN / GIVEN BY / CHECK / TIME
4 / T=0 hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
T+12hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
5 / T=0 hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
T+12hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
6 / T=0 hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs
T+12hr / Cytarabine 100mg/m2 Q12H / mg / IV / Bolus
Cytarabine 500mg/m2 Q12H / mg / IV / In 500ml 0.9S over 3 hrs

Note: Give prednisolone eyedrops 1% starting 12 hours before cytarabine and continue for 5 days after completion. Chart on QMR4.

Authorised by Clinical Director: S Gibbons Pharmacist: B Harden / 20 November 2007
G:\Division\HAE\CLIN\USER\Jen\Chemo charts\AML\AML 15 - relapsed or refractory IDA-ARA C.doc / Ref: 2000
CHEMOTHERAPY
MEDICATION
CHART
C260070