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$ Ensure that melphalan is administered on a week day (Mondays optimal timing for stem cell collection).

or Tuesdays provide

Administration

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

610 • 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 moderately 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.

• Consider H2 antagonist or PPI.

• Consider starting G-CSF 5mg/kg/d on day 9 either to shorten neu-tropenia or to facilitate peripheral blood stem cell collection around day 18.

• Note: do not use mini-BEAM if creatinine clearance <40mL/min.

• 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.

• A second course can be given when neutrophils >1.0 x 109/L and platelets (unsupported) >100 x 109/L; generally 4-6 weeks.

• Consolidate with high dose therapy and in responding patients autologous stem cell transplant.

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