Difference between revisions of "Example orders for R-CHOP in lymphoma"
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m (Text replace - "Diphendyramine" to "Diphenhydramine") |
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*[[Pegfilgrastim (Neulasta)]] 6 mg SC x1 on day 3 | *[[Pegfilgrastim (Neulasta)]] 6 mg SC x1 on day 3 | ||
*Acetaminophen (Tylenol) 650 mg PO 30-60 minutes prior to rituximab | *Acetaminophen (Tylenol) 650 mg PO 30-60 minutes prior to rituximab | ||
− | * | + | *Diphenhydramine (Benadryl) 25-50 mg PO/IV 30-60 minutes prior to rituximab. 50 mg to be used for the first dose of rituximab. Dose may be reduced to 25 mg on subsequent rituximab 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 infusion reaction, may repeat x1 | *Hydrocortisone (Cortef) 50 mg IV prn rituximab infusion reaction, may repeat x1 |
Revision as of 04:44, 3 July 2012
Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.
R-CHOP
R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone
Original reference may be found at R-CHOP (Non-Hodgkin lymphoma)
Example regimen #1
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV on day 1
- Infuse over 30-45 minutes.
- Doxorubicin (Adriamycin) 50 mg/m2 IV on day 1
- Administer IV push through running IV.
- Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV on day 1
- Administer IV push through running IV. Make sure to address patient's bowel status.
- Prednisone (Sterapred) 100 mg PO on days 1-5
- Rituximab (Rituxan) 375 mg/m2 IV on day 1
- Infusion rate per hospital policy.
21-day cycles x 6 cycles
Supportive medications:
- Pegfilgrastim (Neulasta) 6 mg SC x1 on day 3
- Acetaminophen (Tylenol) 650 mg PO 30-60 minutes prior to rituximab
- Diphenhydramine (Benadryl) 25-50 mg PO/IV 30-60 minutes prior to rituximab. 50 mg to be used for the first dose of rituximab. Dose may be reduced to 25 mg on subsequent rituximab treatments if tolerated.
- Ondansetron (Zofran) 8 mg IV 30 minutes prior to CHOP
- Hydrocortisone (Cortef) 50 mg IV prn rituximab infusion reaction, may repeat x1
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:
- Prednisone (Sterapred) as described above
- Ondansetron (Zofran) 8 mg PO Q8H prn nausea
- Acyclovir (Zovirax) 400 mg PO Q8H
- Allopurinol (Aloprim) 100-300 mg PO daily, adjusted for renal function
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.