Difference between revisions of "Example orders for R-CHOP in lymphoma"

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Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
 
Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
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**Administer IV push through running IV.
 
**Administer IV push through running IV.
 
*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2mg per cycle) IV on day 1
 
*[[Vincristine (Oncovin)]] 1.4 mg/m<sup>2</sup> (maximum dose of 2mg per cycle) IV on day 1
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**Administer IV push through running IV. Make sure to address patient's bowel status.    
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**Administer IV push through running IV. Make sure to address patient's bowel status.  
 
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
 
*[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
 
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV on day 1
 
*[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV on day 1
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'''21-day cycles x 6 cycles'''
 
'''21-day cycles x 6 cycles'''
  
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====Supportive medications====
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====Supportive therapy====
 
*[[Pegfilgrastim (Neulasta)]] 6 mg SC x1 on day 3
 
*[[Pegfilgrastim (Neulasta)]] 6 mg SC x1 on day 3
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*[[Acetaminophen (Tylenol)]] 650 mg PO 30 to 60 minutes prior to [[Rituximab (Rituxan)]]
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*[[Acetaminophen (Tylenol)]] 650 mg PO 30 to 60 minutes prior to rituximab
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*[[Diphenhydramine (Benadryl)]] 25 to 50 mg IV or PO 30 to 60 minutes prior to [[Rituximab (Rituxan)]]. 50 mg to be used for the first dose of [[Rituximab (Rituxan)]]. Dose may be reduced to 25 mg on subsequent [[Rituximab (Rituxan)]] treatments if tolerated.
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*[[Diphenhydramine (Benadryl)]] 25 to 50 mg IV or PO 30 to 60 minutes prior to rituximab. 50 mg to be used for the first dose of [[Rituximab (Rituxan)]]. Dose may be reduced to 25 mg on subsequent [[Rituximab (Rituxan)]] treatments if tolerated.
 
*[[Ondansetron (Zofran)]] 8 mg IV 30 minutes prior to CHOP
 
*[[Ondansetron (Zofran)]] 8 mg IV 30 minutes prior to CHOP
 
*[[Hydrocortisone (Cortef)]] 50 mg IV prn [[Rituximab (Rituxan)]] infusion reaction, may repeat x1
 
*[[Hydrocortisone (Cortef)]] 50 mg IV prn [[Rituximab (Rituxan)]] infusion reaction, may repeat x1
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*On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr as part of a comprehensive metabolic panel, alk phos, AST, ALT, total bilirubin, albumin, LDH
 
*On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr as part of a comprehensive metabolic panel, alk phos, AST, ALT, total bilirubin, albumin, LDH
 
**Physician to be notified if liver function tests or bilirubin are not within normal limits
 
**Physician to be notified if liver function tests or bilirubin are not within normal limits
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*On day 8, check nadir CBC with differential, absolute neutrophil count (ANC). Need for further nadir count checks to be determined by degree of cytopenias.
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*On day 8, check nadir CBC with differential, absolute neutrophil count (ANC). Need for further nadir count checks to be determined by degree of cytopenias.
 
*Check hepatitis B status prior to therapy with rituximab
 
*Check hepatitis B status prior to therapy with rituximab
  
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*[[Prednisone (Sterapred)]] as described above
 
*[[Prednisone (Sterapred)]] as described above
 
*[[Ondansetron (Zofran)]] 8 mg PO every 8 hours prn nausea
 
*[[Ondansetron (Zofran)]] 8 mg PO every 8 hours prn nausea
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*[[Acyclovir (Zovirax)]] 400 mg PO Q8H
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*[[Acyclovir (Zovirax)]] 400 mg PO every 8 hours
 
*[[Allopurinol (Zyloprim)]] 100 to 300 mg PO once per day, adjusted for renal function  
 
*[[Allopurinol (Zyloprim)]] 100 to 300 mg PO once per day, adjusted for renal function  
  
 
'''Clinical scenario & comments:'''
 
'''Clinical scenario & comments:'''
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*74 year-old gentleman with diffuse large B-cell lymphoma (DLBCL), using R-CHOP as first-line therapy. This patient had a creatinine of 1.4, with calculated creatinine clearance by Cockcroft-Gault of 55, but the team chose to be more conservative with allopurinol dosing and used 100 mg PO daily.
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*74 year-old gentleman with diffuse large B-cell lymphoma (DLBCL), using R-CHOP as first-line therapy. This patient had a creatinine of 1.4, with calculated creatinine clearance by Cockcroft-Gault of 55, but the team chose to be more conservative with allopurinol dosing and used 100 mg PO daily.
  
 
[[Category:Example chemotherapy order sets]]
 
[[Category:Example chemotherapy order sets]]

Latest revision as of 01:42, 1 June 2023


Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.


R-CHOP

R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone

Original references may be found at R-CHOP (Non-Hodgkin lymphoma)

Example regimen #1

21-day cycles x 6 cycles

Supportive therapy

Hydration:

  • Prehydration with 500 ml NS at 500 mL/hour, to start 60 minutes before chemotherapy
  • 500 ml NS at KVO rate to be used as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

  • On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr as part of a comprehensive metabolic panel, alk phos, AST, ALT, total bilirubin, albumin, LDH
    • Physician to be notified if liver function tests or bilirubin are not within normal limits
  • On day 8, check nadir CBC with differential, absolute neutrophil count (ANC). Need for further nadir count checks to be determined by degree of cytopenias.
  • Check hepatitis B status prior to therapy with rituximab

Outpatient medications:

Clinical scenario & comments:

  • 74 year-old gentleman with diffuse large B-cell lymphoma (DLBCL), using R-CHOP as first-line therapy. This patient had a creatinine of 1.4, with calculated creatinine clearance by Cockcroft-Gault of 55, but the team chose to be more conservative with allopurinol dosing and used 100 mg PO daily.
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