Canterbury Regional Cancer and Blood Service (Haematology)Page 1 of 12

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
Cycle length: / 28 days / Day 1 / Limits / Day 1 / Limits / Allergies/hypersensitivities
Antiemetics
Domperidone 10mg PO QID
± Cyclizine 50mg PO/IV TDS / Agent
Methotrexate (low dose)
Methotrexate (high dose)
Peg-Asparaginase
Folinic acid
DOSE MODIFIED:NO YESNoYes / Round
5mg
100mg
75 units (IU)
oral 7.5mg, IV 5mg
Date / Date
Destination: / BMTU / Neuts / > 0.75 X 109/L / Bili / 50 umol/L
Plts / > 75 X 109/L / AST / 180 U/L
CrCl / see below
Reference: UKALL14 – Protocol – v5.0 – 20/07/12
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
Continuous / Imatinib
(Philadelphia +ve patients only) / mg / PO / Continuous for patients with Philadelphia positive disease. Continuous daily Imatinib, PO, aiming to escalate to 600mg, if tolerated. This should be continued until transplant wherever possible. Prescribe on regular medication chart.
-1 / 2200 / Ural Sachet® / 1 / PO / Dissolved in 20mL water
2200 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
T= -1 hr / Ondansetron / 8 / mg / PO / Give 1 hour prior to chemotherapy
T= -1 hr / Dexamethasone / 8 / mg / PO / Give 1 hour prior to chemotherapy
T= 0 hrs / Methotrexate300mg/m2 / mg / IV / In 250 mLsodium chloride 0.9% over 1hour / 250mL/hr
T= +1 hr / Methotrexate2700mg/m2 / mg / IV / In 1000 mL sodium chloride 0.9 % over 23 hours / 46mL/hr (rate incl 50mL flush)
  • Measure serum creatinine and calculate CrCl one week prior to methotrexate infusion. If CrCl < 80 mL/min, adjust methotrexate dose as per protocol (appendix 15)
  • IV fluids run concurrently with chemotherapy. Check fluid balance at least 4 hourly, consider frusemide if urine output falls below 400 mL/m2 in any 4 hour period, or 1kg weight increase
  • Urine pH must be > 7.5 before starting methotrexate - adjust sodium bicarbonate to keep pH between 7 and 8 during infusion and subsequent folinic acid rescue
  • Stop proton pump inhibitors (omeprazole/pantoprazole/lansoprazole)the day prior to methotrexate infusion, restart once methotrexate has cleared
  • It is recommended prophylactic trimethoprim/sulphamethoxazole (co-trimoxazole) be stopped one week before methotrexate therapy, until maintenance therapy starts

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
1 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
T= +12hrs / Ondansetron / 8 / mg / PO/IV
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
2 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
Ondansetron / 8 / mg / PO
Dexamethasone / 8 / mg / PO
T=+24hrs / Stop Methotrexate infusion / Record the amount infused
# Peg-Asparaginase 1000 units/m2 / units / IV / In 100mL sodium chloride 0.9 % over at least 1 hour
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)
  • Check Antithrombin III and Fibrinogen every 2 days while receiving Peg-Asparaginase

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
2 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
T= +36 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
T= +39 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
T= +42 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
T= +45 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
3 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
Dexamethasone / 8 / mg / PO
T= +48 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
T=+48 hrs / Methotrexate level / Continue folinic acid until methotrexate level < 0.1 umol/L. Notify lab if levels required over the weekend.
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
T= +51 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
Folinic acid ____ mg/m2
(frequency and dose depends on 48 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
4 / Folinic acid ____ mg/m2 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
T=+72 hrs / Methotrexate level / Continue folinic acid until methotrexate level < 0.1 umol/L. Notify lab if levels required over the weekend.
Folinic acid ____ mg/m2
(dose depends on 48 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
Folinic acid ____ mg/m2
(frequency and dose depends on 72 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
Folinic acid ____ mg/m2 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
5 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
Folinic acid ____ mg/m2 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
T=+96 hrs / Methotrexate level / Continue folinic acid until methotrexate level < 0.1 umol/L. Notify lab if levels required over the weekend
Folinic acid ____ mg/m2
(dose depends on 72 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / ml/hr
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)
  • If further folinic acid required, prescribe on regular medication chart

Consultant:

NZMC Reg. No:

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = ml/hr
Destination: / BMTU / Day 15 / Limits / Day 15 / Limits / Allergies/hypersensitivities
Antiemetics
Domperidone 10mg PO QID
± Cyclizine 50mg PO/IV TDS / Agent
Methotrexate (low dose)
Methotrexate (high dose)
Peg-Asparaginase
Folinic acid
DOSE MODIFIED:NO YESNoYes / Round
5mg
100mg
75 units(IU)
oral 7.5mg, IV 5mg
Date / Date
Neuts / > 0.75 X 109/L / Bili / 50 umol/L
Plts / > 75 X 109/L / AST / 180 U/L
CrCl / see below
Reference: UKALL14 – Protocol – v5.0 – 20/07/12

NB. Above limits must be met before commencing day 15 chemotherapy

Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
Continuous / Imatinib
(Philadelphia +ve patients only) / mg / PO / Continuous for patients with Philadelphia positive disease. Continuous daily Imatinib, PO, aiming to escalate to 600mg, if tolerated. This should be continued until transplant whenever possible. Prescribe on regular medication chart.
14 / 2200 / Ural Sachet® / 1 / PO / Dissolved in 20mL water
2200 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
15 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
T= -1 hr / Ondansetron / 8 / mg / PO / Give 1 hour prior to chemotherapy
T= -1 hr / Dexamethasone / 8 / mg / PO / Give 1 hour prior to chemotherapy
T= 0 hrs / Methotrexate300mg/m2 / mg / IV / In 250 mLsodium chloride 0.9% over 1hour / 250mL/hr
T= +1 hr / Methotrexate2700mg/m2 / mg / IV / In 1000 mL sodium chloride 0.9 % over 23 hours / 46mL/hr (rate incl 50mL flush)

See prescribing notes over page

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = ml/hr
  • Patients with CrCl between 80-100 mL/min before the first dose of methotrexate MUST have a measured creatinine clearance (24 hour urine collection) BEFORE the second dose. If CrCl < 80 mL/min, adjust methotrexate dose as per protocol (appendix 15)
  • IV fluids run concurrently with chemotherapy. Check fluid balance at least 4 hourly, consider frusemide if urine output falls below 400 mL/m2 in any 4 hour period, or 1kg weight increase
  • Urine pH must be > 7.5 before starting methotrexate - adjust sodium bicarbonate to keep pH between 7 and 8 during infusion and subsequent folinic acid rescue
  • Stop proton pump inhibitors (omeprazole/pantoprazole/lansoprazole) the day prior to methotrexate infusion, restart once methotrexate has cleared
  • It is recommended prophylactic trimethoprim/sulphamethoxazole (co-trimoxazole) be stopped one week before methotrexate therapy, until maintenance therapy starts

Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
15 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
T= +12 hrs / Ondansetron / 8 / mg / PO/IV
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
16 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = ml/hr
16 / Ondansetron / 8 / mg / PO
Dexamethasone / 8 / mg / PO
T= +24 hrs / Stop Methotrexate infusion / Record the amount infused
# Peg-Asparaginase 1000 units/m2 / units / IV / In 100mL sodium chloride 0.9 % over at least 1 hour
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125 mL/m2/hr / mL/hr
T= +36 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
T= +39 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
T= +42 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
T= +45 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)
  • Check Antithrombin III and Fibrinogen every 2 days while receiving Peg-Asparaginase

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = ml/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
17 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
Dexamethasone / 8 / mg / PO
T =+48 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
T= +48 hrs / Methotrexate level / Continue folinic acid until methotrexate level < 0.1 umol/L. Notify lab if levels required over the weekend.
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
T= +51 hrs / Folinic acid / 30 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
Folinic acid ____ mg/m2
(frequency and dose depends on 48 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)

UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
18 / Folinic acid ____ mg/m2 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
T= +72 hrs / Methotrexate level / Continue folinic acid until methotrexate level < 0.1 umol/L. Notify lab if levels required over the weekend.
Folinic acid ____ mg/m2
(dose depends on 48 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
Folinic acid ____ mg/m2
(frequency and dose depends on 72 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
Folinic acid ____ mg/m2 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
UKALL 14
Intensification / CNS prophylaxis / Height / cm
Weight / kg
BSA / m2
Infusion rate125 X BSA / = mL/hr
19 / 1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
Folinic acid ____ mg/m2 / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
T= +96 hrs / Methotrexate level / Continue folinic acid until methotrexate level < 0.1 umol/L. Notify lab if levels required over the weekend.
Folinic acid ____ mg/m2
(dose depends on 72 hour methotrexate level) / mg / PO / Give IV bolus if PO not tolerated
1000 mL glucose 4 % & sodium chloride 0.18 %
+ 30 mmol potassium chloride
+ 50 mmol sodium bicarbonate / IV / Infuse at 125mL/m2/hr / mL/hr
  • Continue folinic acid and high dose fluids for at least 48 hours, and continue as per UKALL 14 protocol depending on methotrexate levels (appendix 15)
  • If further folinic acid required, prescribe on regular medication chart

Consultant:

NZMC Reg. No:

Authorised by: Dr P GanlyPharmacists: C Innes / B Harden / August 2012
Reviewed: April 2016
CHEMOTHERAPY
MEDICATION
CHART
C260070