BEAM. Lymphoma group OxBMT SCHEDULE SUMMARY. Date:

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1 xbt SCHEDULE SUARY Date: Day DRUG Admission Carmustine (BCNU) Etoposide Cytarabine (Ara-C) elphalan Stem cell infusion Pentamidine* To prevent a specific pneumonia called PCP Cyclizine (C) Dexamethasone (D) etoclopramide () ndansetron () Different anti-sickness D * Intravenous pentamidine for PCP prophylaxis should be considered for all patients during conditioning chemotherapy. Day +1 is the most logistically feasible time. If this falls at a weekend, defer to the next working day. D C 1 of 5

2 xbt INDICATIN Hodgkin and non-hodgkin lymphoma. TREATENT INTENT Curative/ Disease odification PRE-ASSESSENT 1. Ensure pre-transplant investigations are carried out as per protocol Ba 2. Ensure patient has double lumen central line inserted and working. 3. Ensure results of pre-transplant investigations are checked by a Haematology SpR and recorded in patient record. 4. Haematology SpR to complete electronic BT front sheet B.2.16g and to BT Administrator to distribute and file in patient record. 5. Treating Consultant to prescribe chemotherapy and stem cells at least 5 days before admission. 6. Supportive treatment to be prescribed by Haematology SPR at least 5 days before admission 7. Send Stem cells and Immunotherapies final report of donation and processing form v4.3.3 SCI at least 7 working days before the planned collection date and ensure a copy is placed in the medical notes 8. Ensure the patient receives irradiated blood products from the start of conditioning. See Guidelines for the use of blood components in adult haematology' for details and individual requirements / duration post-autograft. Ensure irradiation card is attached to the patient's notes and copy given to the patient. 9. Ensure pregnancy test is carried out on all women of child-bearing age unless they are postmenopausal, have been sterilised or have undergone a hysterectomy. 10. Consider NG Tube for feeding to be put in at Day Treatment should be agreed in the relevant DT. 2 of 5

3 xbt CHETHERAPY AND FLUIDS Encourage 3L oral fluids daily, give IV if oral intake insufficient. Day -6 Day -5 to -2 Day -5 to -2 Day -1 Day 0 CARUSTINE (BCNU) ETPSIDE CYTARABINE ELPHALAN Stem cell reinfusion (min 24 hrs post elphalan) 300 mg/m 2 IV D in 500 ml 5% glucose over 1 hour 200 mg/m 2 IV D in 1000 ml sodium chloride 0.9% over 2 hours 200 mg/m 2 IV BD in 100 ml sodium chloride 0.9% over 30 mins 06.00: 1000 ml sodium chloride 0.9% IV infusion over 4 hours 10.00: 140 mg/m 2 IV D in 100 ml sodium chloride 0.9% over 30 mins 10.30: 1000 ml sodium chloride 0.9% with 20 mmol potassium chloride IV infusion over 8 hours 06.00: 1000 ml sodium chloride 0.9% iv infusion over 6 hours Give hydrocortisone 100 mg IV, chlorphenamine 10 mg IV and cyclizine 50 mg IV 15 minutes before infusion. Day +1 Pentamidine 4 mg/kg IV in 100mL sodium chloride 0.9% over 1 hour, maximum 300 mg. Day +5 G-CSF SC Daily as per local policy until stable engraftment. NB: Document infusion details in medical notes, volume, number and ID of the bags given. NB: For obese patients refer to NSSG Guideline Guidelines on Dosing in bese Adult Patients undergoing Stem-cell / Bone arrow transplant. Administration of chemotherapy: Refer to nursing care plan N.3. Pentamidine: Refer to nursing care plan for administration N.73. Stem cell re-infusion: Refer to nursing care plan N.30. DSE DIFICATIN All dose modification to be discussed with consultant. ELPHALAN Renal Impairment Creatinine clearance ml/min elphalan dose > mg/m mg/m 2 <30 Clinical decision 3 of 5

4 xbt CARUSTINE Consider omitting BCNU if lung function tests < 75% predicted or heavy smoker. Renal Impairment limited data available, clinical decision Creatinine clearance ml/min Carmustine dose >45 - <60 80% % <30 Clinical decision ETPSIDE Renal impairment CrCl >50 ml/min CrCl ml/min CrCl <15 ml/min 100% dose 75% dose 50% dose Hepatic impairment - discuss with consultant Arguments for and against dose reduction. Bilirubin 26-51micromol/L or AST u/L -50% dose Bilirubin >51micromol/L or AST >180u/L -clinical decision INVESTIGATINS Daily FBC, U&E, urinalysis & weight on/wed/fri LFT, g 2+ and Ca 2+ (more frequently if clinically indicated) on/thurs Group and save & coagulation screen Chest X-ray on admission then as clinically indicated. CNCURRENT EDICATIN Norethisterone Fluconazole PPI 5-10 mg P TDS from day 0 until platelets >50 x 10 9 /L (menstruating women only). 50 mg P D from day 0 until neutrophils >1.0 x 10 9 /L (or longer if patient on steroids). Refer to Antifungal protocol. antifungal-therapy-guidelines.pdf meprazole 20mg D from start of conditioning until platelet count >50 x 10 9 /L. (or PPI as per local formulary) Aciclovir 200 mg P TDS (or 250 mg TDS IV) from day 0 until day +90. G-CSF SC Daily from Day +5 as per local policy until stable engraftment. Pentamidine 4mg/kg/day (max 300mg) iv on day+1 and day +30 (unless started on co-trimoxazole). 4 of 5

5 xbt ANTI-EETICS Days -6 to -1 Days -6 AND -1 Days -5 to -2 Day 0 5HT 3 antagonist (e.g. ndansetron 8mg IV/P BD) Dexamethasone 8 mg IV D etoclopramide mg IV/P TDS Cyclizine 50 mg IV/P TDS EDICATIN N DISCHARGE (TTS) Norethisterone Fluconazole Stop when platelets >50 x 10 9 /L (menstruating women only). Stop when neutrophils >1.0 x 10 9 /L (or longer if patient on steroids). Co-trimoxazole 480 mg daily on, Wed, Fri until day Start when neutrophils >1.0 x 10 9 /L. If allergic to co-trimoxazole, pentamidine 4 mg/kg IV (max 300 mg) monthly. Aciclovir 200 mg TDS P until day +90. PPI Stop when platelet count >50 x 10 9 /L unless clinically indicated. TREATENT RELATED RTALITY 3-5% REFERENCES 1. ills W, Chopra R, cillan A, Pearce R, Linch DC, Goldstone AH. chemotherapy and autologous bone marrow transplantation for patients with relapsed or refractory non-hodgkin's lymphoma. J Clin ncol ar;13(3): UCLH - Dosage Adjustment for Cytotoxics in Hepatic Impairment ( 3 - updated January 2009). 3. UCLH - Dosage Adjustment for Cytotoxics in Renal Impairment ( 3 - updated January 2009). 5 of 5