Chemotherapy Charts Burkitt-Type Lymphoma R MTX Cytarabine Cycles 2 and 4

Haematology / Page 1 of 7
NHL – Burkitt-type Lymphoma
R- MTX Ara C
This alternates with Hyper-CVAD / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Cycle length: / 21 days / CBC / Day 1 / Limits / Allergies/hypersensitivities
Antiemetics
± domperidone 10-20mg PO QID
± Lorazepam 1-2mg PO daily / Agent
Methotrexate day 1
Cytarabine Q12H days 2 and3
Steroid eye drops
Folinic acid
DOSE MODIFIED:NO YESNoYes / Round
100mg
100mg
Cycle no / 2 4 2 of 84 of 8 / Date
Destination / Neuts / > 1 X 109/L
Plts / > 50 X 109/L
Reference: Thomas et al Cancer, 2006106(7) 1569-1580
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
-1 / Methotrexate 12mg IT / See intrathecal chemotherapy chart
-1 / 2200 / Ural Sachet® / 1 / PO / Dissolved in 20mL water
1 / t-5 hr / 0400 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
0800 / Dexamethasone / 8 / mg / PO / 30-60 minutes prior to chemo
0800 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse as 125ml/m2/hr / ml/hr
T = 0
0900 / Methotrexate 200mg/m2 / mg / IV / 250ml 0.9% S over 2 hrs / 125ml/hr
1100 / Methotrexate 800mg/m2 / mg / IV / 1000ml 0.9% S over 22 hrs / 46ml/hr

RItuximab is given for the first 4 cycles only – 8 doses. See recording chart page 5
IV fluids run concurrently with chemotherapy, continue for 48 hours from the start of the MTX infusion.
Calculate the rate of infusion based on patient surface area and prescribe in the rates column. Modify rate if there is evidence of overload, consider frusemide
Urine pH must be > 7.5 before starting methotrexate. Adjust NaHCO3 to keep pH between 7 and 8.
Chart prednisolone eye drops QID from days 2-8
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.
Stop proton pump inhibitor the day prior to MTX infusion. Restart once MTX has cleared.

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
NHL – Burkitt-type Lymphoma
R- MTX Ara C
This alternates with Hyper-CVAD / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
1 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
2000 / Ondansetron / 8 / mg / PO/IV
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
2 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0800 / Dexamethasone / 8 / mg / PO / 30-60 minutes prior to chemo
0800 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
0900 / Stop Methotrexate infusion
0900 / Methotrexate level. If >20micromol/L then reduce cytarabine dose to 1g/m2.
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
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr

See rituximab recording chart page 6

NHL – Burkitt-type Lymphoma
R- MTX Ara C
This alternates with Hyper-CVAD / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Rate / Doctor / Nurse / Check / Start / Stop
2 / 0800 / Ondansetron / 8 / mg / PO/IV
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
T =+36hr
2100 / Folinic acid / 50 / mg / IV / Slow bolus 36 hrs after start of MTX
2100 / *Cytarabine 30001000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
3 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0300 / Folinic acid / 15 / mg / IV
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0800 / Dexamethasone / 8 / mg / PO / 30-60 minutes prior to chemo
0800 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid / 15 / mg / IV
0900 / *Cytarabine 30001000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
1500 / Folinic acid / 15 / mg / IV
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
2000 / Ondansetron / 8 / mg / PO/IV

* Reduce cytarabine dose to 1000mg/m2 for patients ≥ 60 yrs, or if MTX level >20micromol/L at end of MTX infusion, or if creatinine ≥ 132µmol/L

NHL – Burkitt-type Lymphoma
R- MTX Ara C
This alternates with Hyper-CVAD / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
3 / 2100 / Folinic acid / 15 / mg / IV
2100 / *Cytarabine 30001000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
4 / 1000ml 0.9S + 30mmol KCl and 50mmol NaHCO3 / IV / Infuse at 125ml/m2/hr / ml/hr
0300 / Folinic acid / 15 / mg / IV
0800 / Dexamethasone / 8 / mg / PO / 30-60 minutes prior to chemo
0800 / Ondansetron / 8 / mg / PO/IV / 30-60 minutes prior to chemo
0900 / Methotrexate level / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. Notify labs if MTX levels will be required over a weekend.
0900 / Folinic acid / 15 / mg / IV
0900 / *Cytarabine 30001000mg/m2(Q12H) / mg / IV / In 500ml 0.9% saline over 2 hrs
1500 / Folinic acid / 15 / mg / PO
2000 / Ondansetron / 8 / mg / PO/IV
2100 / Folinic acid / 15 / mg / PO / Aim <0.1micromol/l. If > 0.1micromol/l increase folinic acid to 50mg IV Q12H until the level is <0.1micromol/l. CHART ON QMR4. Notify labs if MTX levels will be required over a weekend
5 / 0800 / Dexamethasone / 8 / mg / PO
0800 / Ondansetron / 8 / mg / PO/IV
1700 / Pegylated GCSF / 6 / mg / SC
8 / Cytarabine 100mg IT / See intrathecal chemotherapy chart
NHL – Burkitt-type Lymphoma
R- MTX Ara C
This alternates with Hyper-CVAD / Height / cm
Weight / kg
BSA / M2
Infusion rate
125 X BSA / = mL/hr
Day / Date / Time / Agent / Dose / Route / Instructions / Doctor / Nurse / Check / Start / Stop
8 / T= -60 mins / Methylprednisone / 100 / mg / IV / In 100ml 0.9% saline over 15 mins
T= -60 mins / Paracetamol / 1000 / mg / PO / 30-60 minutes prior to rituximab
T= -60 mins / 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

See Rituximab recording chart page 7

Authorised by S Gibbons Pharmacist: B Harden / Updated: February 2015
T:\Pictures\CDHB\Red_Book\NHL Burkitt-type lymphoma Ritux MTX cytarabine cycles 2 and 4.docx / Review 2016
CHEMOTHERAPY
MEDICATION
CHART
C260070

Haematology / Page 1 of 7
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 50 mg increments every 30 minutes to a maximum rate of 400 mg/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 100 mg 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 S GibbonsPharmacist: B Harden / Updated: February 2015
T:\Pictures\CDHB\Red_Book\NHL Burkitt-type lymphoma Ritux MTX cytarabine cycles 2 and 4.docx / Review 2016