Emetogenicity level 1. Emetogenicity level 2
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1 Emetogenicity level 1 15 mins Pre-Chemo Maxalon 10mg po During chemo and Post Chemo 3 days Maxalon10mg po 8 hourly Increase Maxalon 20mg po 8 hourly Change to Cyclizine 50mg po 8 hourly 3 days If nausea is controlled use this next cycle, if not then Prescribe as level 2 Emetogenicity level 2 15 mins Pre-Chemo Maxalon 20mg po During chemo and Post Chemo for 3 to 5 days Maxalon 10mg po 8 hourly Increase Maxalon 20mg po 8 hourly Change to Cyclizine 50mg po 8 hourly for 3 to 5 days Notes If anticipatory / breakthrough nausea experienced consider Lorazepam 1mg prn. If absorption / nausea / swallowing problematic change to IV / SC 27/08/2008 Version 1.1
2 Emetogenic Potential of Single Chemotherapeutic Agents Alemtuzumab Low/None <10% Level 1 Asaparaginase Bleomycin Busulfan <20 mg Chlorambucil Cladribine Fludarabine Fluoropyrimidines po Hydroxyurea Mecaptopurine Melphalan po Rituximab Thiogaunine po Vinblastine Vincristine Vindesine Vinorelbine Capcitabine Mild 10-30% Level 2 Cyclophosphamide po Docetaxel Etoposide po & <500mg/m 2 5-fluorouracil <1g/m 2 Gemcitabine Liposomal Doxorubicin Liposomal Daunorubicin Lomustine <60mg/m 2 Methotrexate >50mg/m 2 and <250mg/m 2 Mitomycin Paclitaxel Ralitrexed Temozolomide Topotecan Amsacrine Mild/Moderate 30-60% Level 3 Busulfan 20-40mg/m 2 Clofarabine Cyclophosphamide <750mg/m 2 Cytarabine <1g/m 2 Dactinomycin <1.5g/m 2 Daunorubicin Doxorubicin 20-60mg/m 2 Epirubicin <90mg/m 2 Etoposide>500mg/m 2 Gemtuzumab Ozogamicin Ifosfamide <1.2g/m 2 Melphalan <100mg/m 2 Methotrexate mg/m 2 Mitoxantrone <15mg/m 2 Procarbazine po Treosulfan Moderate/High 60-90% Level 4 Busulfan >40mg/m 2 Carboplatin Carmustine Cisplatin<50mg/m 2 Cyclophosphamide mg/m 2 Cytarabine >1g/m 2 Dactinomycin >1.5mg/m 2 Daunorubicin Doxorubicin >60mg/m 2 Epirubicin Idarubicin Ifosfamide >1.5mg/m 2 Irinotecan Melphalan>100mg/m 2 Methotrexate >1000mg/m 2 Mitoxantrone >1.5mg/m 2 Mustine Oxaliplatin Actinomycin-D High >90% Level 5 Cisplatin >50mg/m 2 Cyclophosphamide >1.5mg/m 2 Dacarbazine Lomustine >60mg/m 2 Pentostatin Streptozocin Hesketh P et al (1997) Proposal for classifying the acute emetogenicity of cancer chemotherapy Journal of Clinical Oncology /08/2008 Version 1.1
3 Emetogenic Potential of Regimens Low/None <10% Level 1 Mild 10-30% Level 2 Mild/Moderate 30-60% Level 3 Moderate/High 60-90% Level 4 Alemtuzumab 5 days ChlVPP see regimen and prescribe according to single chemotherapy emetogency Cladribine 7 days Fludarabine 5 days Rituximab 1 day UKAL XII Maintenance 2 see regimen and prescribe according to single chemotherapy emetogenicity CVP (oral cyclophosphamide) 1 day Low Dose Cytarabine (AML 14) 10 days UKALL XII CNS Chemotherapy (Cytarabine IT) see regimen and prescribe according to single chemotherapy emetogencity CloD 5 days Clofarabine 5 days C-Weekly 1 day CVP (IV Cyclophosphamide) 1 day FMD (oral fludarabine) 1 day FMD + Rituximab 1 day Gemtuzumab Ozogamicin 1 day MINIGRAFT For NHL 8 days Mitoxantrone Spanish Arm Course 3 5 days REDUCED INTENSITY ALLOGENEIC TRANSPLANT (FLUDARABINE,CYCLO, ALG) 4 days UKALL XII INDUCTION (PHASE 1) see regimen and prescribe according to single chemotherapy emetogenicity UKALL XII (MaintenanceChemotherapy) see regimen and prescribe according to single chemotherapy emetogenicity VAD 4 days ABVE 1 day CHOP/14/RITUXIMAB 1 day C-VAMP 4 days CYTARABINE 1.5mg/m 2 (AML 15) 5 days CYTARABINE 3g/m 2 5 days DA days DA days DA days DAT days DAT days DAT days DAT days FLA 5 days H-DAT days H-DAT days High Dose Melphalan Auto1 day High Dose Methotrexate 1 day Idarubicin Spanish Arm Course 1 8 days Idarubicin Spanish Arm Course 2 4 days Idarubicin Spanish Arm Course 4 1 day MACE 5 days MUD ALEMTUZUMAB + CYCLOPHOSPHAMIDE +TBI 12 days 27/08/2008 Version 1.1 High >90% Level 5 ABCM 1 day ABVD 1 day ADE days ADE days ADE (AML 15) 10 days ALLOGENIC TRANSPLANT HIGH DOSE CYCLOPHOSPHAMIDE 3 days BEAM 6 days BEACOPP 8 days BUCY ALLO 14 days BUCY AUTO 6 days CODOX-M (LY10)<65yrs/>65yrs 10 days CYCLOPHOSPHAMIDE 1.5g 5 days CYCLOPHOSPHAMIDE +TBI ALLO 12 day CYCLOPHOSPHAMIDE + CAMPATH+TBI UNRELATED ALLO 8 days CYCLOPHOSPHAMIDE +TBI AUTO 6 days CYTARABINE 1.5mg/m 2 + Gemtuzumab 3mg/m 2 5 days CYTARABINE 3mg/m 2 + Gemtuzumab 3mg/m 2 5 days
4 VAMP 4 days MINIGRAFT CONDITIONING (MUD) 8 days MINIGRAFT CONDITIONING (FLUDARABINE and MELPHALAN) 6 days Mitoxantrone + Gemtuzumab Spanish Arm Course 3 5 days REDUCED INTENSITY ALLOGENEIC TRANSPLANT (FLUDARABINE,MELPHALAN) 6 days REDUCED INTENSITY ALLOGENEIC TRANSPLANT (FLUDARABINE,+CAMPATH+MELPHALAN) 7 days S-DAT days S-DAT days UKALL X INDUCTION see regimen and prescribe according to single chemotherapy emetogenicity UKALL XII INDUCTION 2 see regimen and prescribe according to single chemotherapy emetogenicity UKALL 12 Consolidation Cycle 1 8 days UKALL 12 Consolidation Cycle 2 5 days UKALL 12 Consolidation Cycle 4 5 days DA with Gemtuzumab 10 days DTPACE 4 days ESHAP 4 days FLAG-Ida + Gemtuzumab 3mg/m2 6 days FLAG-Ida Course 1 6 days FLAG-Ida Course 2 4 days HIGH DOSE CARBOPLATIN & ETOPOSIDE 5 days HYPER CVAD 4 days ICE 2 days ICE (AML 14) 3 days IVAC 5 days MACE + Gemtuzumab 5 days MELPHALAN-TBI ALLO 12 days MINI-BEAM 6 days MINI-ICE 3 days MidAC 4 days Nottingham Priming Protocol 3 days RAM 5 days R-ICE Course 1 5 days R-ICE Course 2/3 5 days UKALL XA 5 days UKALL 12 Consolidation Cycle 3 see regimen and prescribe according to single chemotherapy emetogenicity Hesketh P et al (1997) Proposal for classifying the acute emetogenicity of cancer chemotherapy Journal of Clinical Oncology /08/2008 Version 1.1
5 Written by: Dr Rachel Elliott, Consultant Haematologist Authorised by: Rachel Hopper, Macmillan Clinical Nurse Specialist Haematology Date for review July /08/2008 Version 1.1
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