Administration

• Out-patient regimen.

• Add allopurinol 300mg od PO (100mg if significant renal impairment) for first cycle.

• Antiemetic therapy for moderately emetogenic regimens.

• Commence H2 antagonist or PPI.

• Nystatin and chlorhexidine mouthcare.

• Oral systemic PCP prophylaxis is recommended until 2 weeks after the end of treatment.

• Consider oral systemic antibacterial, antiviral and/or antifungal prophylaxis if patient is neutropenic.

• Reduce dose of idarubicin by 50% if bilirubin 20-50|_imol/L; caution if bilirubin is >50|_imol/L. Maximum cumulative dose = 400mg/m2.

• Delay treatment for 1 week if neutrophils <1.0 x 109/L or platelets <50 x 109/L. Reintroduce at 300mg or 400mg per dose.

• Consider G-CSF if treatment delays are prolonged or frequent.

• Continue to maximal response, usually 4-6 cycles.

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