Recommended

1. Irradiation of cellular blood products (2500cGy) from day 1 of initiation of therapy and continue until 2 years post-treatment.

2. PCP prophylaxis from start of therapy—usually cotrimoxazole 1 tablet bd Mondays, Wednesdays and Fridays. In patients who are already severely neutropenic, cotrimoxazole may be substituted by pentami-dine nebulisers 300mg 3-weekly with 2.5mg of salbutamol nebuliser pre-treatment. PCP prophylaxis should continue until a year after the end of treatment.

3. HZV prophylaxis—acyclovir 400mg qds is the minimum continuous dose required to prevent HZV reactivation. Most physicians will not wish to have patients continuously on this dosage throughout the treatment cycle and for a year post-treatment so suggest: counsel patients about the risk of shingles and advised to contact the hospital immediately if shingles suspected. Patients who have already had a zoster reactivation should be maintained continuously on acyclovir 400mg qds and continuation of the purine analogue reviewed.

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