Administration

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

• Severe myelosuppression (neutrophils <0.2 x 109/L and need for red cell and platelet transfusion support) should be expected.

• Allopurinol 300mg od PO (100mg if renal impairment) for first 2 cycles.

• Consider acyclovir prophylaxis if previous history of VZV or HSV reactivation.

• Antiemetic therapy for highly emetogenic regimens.

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

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

• Standard antimicrobial prophylaxis as dictated by local policy to cover duration of severe neutropenia.

• G-CSF 5-10mg/kg SC daily starting day +5 optional to shorten neu-tropenia and necessary to mobilise peripheral blood stem cells.

• Reduce cisplatin to 75% dose if creatinine clearance 45-60mL/min, 50% dose if creatinine clearance 30-45mL/min; do not give if creatinine clearance <30mL/min.

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

• Cytarabine should be used with caution in severe renal impairment; consider reducing dose of cytarabine if hepatic impairment.

• Delay next cycle for 1 week if neutrophils <1.0 x 109/L or platelets <100 x 109/L.

• 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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