Administration

• Ensure adequate venous access by inserting a dual lumen tunnelled central venous catheter.

• Severe myelosuppression (neutrophils <0.1 x 109/L and platelets <20 x 109/L) is expected.

• Add allopurinol 300mg (100mg if creatinine clearance <20mL/min) od for first 2 weeks.

• Antiemetic therapy for highly emetogenic regimens.

• Aggressive pre- and post-hydration including potassium/magnesium supplementation required with cisplatin.

• Predsol 0.5% eye-drops qds until 5 days after completion of chemotherapy.

• Give mouth care (nystatin and chlorhexidine M/W) and oral systemic antibacterial and antifungal prophylaxis until neutrophil recovery > 1.0 x 109/L.

• Consider H2 antagonist or PPI.

• Consider starting G-CSF 5mg/kg/day on day 7 either to shorten neutropenia or to facilitate peripheral blood stem cell collection around day 16.

• Reduce cisplatin to 50% dose if creatinine clearance 40-60mL/min; do not give if creatinine clearance <40mL/min.

• Reduce cytarabine to 50% dose and omit etoposide if serum bilirubin >50|jmol/L.

• Creatinine clearance should be assessed before each course of treatment.

• Patients with Hodgkin's lymphoma and those in whom stem cell collection is planned within 2 weeks must receive irradiated cellular blood components to prevent transfusion associated graft versus host disease.

• 2-6 cycles in total but usually consolidated with high dose therapy and autologous stem cell transplant in responding patients <65 years of age.

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