• 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 week.

• Antiemetic therapy for highly emetogenic regimens.

• Give mouth care (nystatin and chlorhexidine M/W) and oral systemic antibacterial and antifungal prophylaxis until neutrophil recovery > 1.0 x 109/L—refer to local protocol for patients with severe neutropenia.

• Consider H2 antagonist or PPI

• Consider starting G-CSF 5mg/kg/day on day +5 to shorten the duration of neutropenia.

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

• Consider oral systemic PCP prophylaxis for 6 months after count recovery—refer to local protocol.

• Do not use BEAM if creatinine clearance is <40mL/min

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