• Out-patient regimen.

• Check direct antiglobulin test (DAGT) pre-treatment; +ve DAGT is a relative contraindication to fludarabine therapy.

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

• Oral systemic PCP prophylaxis according to local protocol (generally 480mg bd tiw) throughout treatment and for 8 weeks after comple-

616 tion.

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

• Antiemetic therapy for moderately emetogenic regimens.

• Reduce to 50% doses if renal impairment (creatinine clearance 30-60mL/min); do not give if creatinine clearance <30mL/min.

• Delay next cycle for 1 week if neutrophils <1 x 109/L or platelets <75 x 109/L.

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