Women of childbearing potential must have negative pregnancy test within 24h before starting thalidomide every 24 weeks while on thalidomide and 4 weeks after last dose

• Add allopurinol 300mg od PO (100mg if significant renal impairment) for first cycle.

• Antiemetic therapy for mildly emetogenic regimens.

• Commence H2 antagonist or PPI.

• Consider regular laxative.

• Do not give cyclophosphamide if serum creatinine >300|_imol/L after rehydration.

• Omit cyclophosphamide for 3 weeks if neutrophils <1.0 x 109/L or platelets <100 x 109/L. Reintroduce

• Consider G-CSF if treatment delays are prolonged or frequent

• Omit thalidomide for one cycle if grade 3/4 constipation, neuropathy, fatigue, sedation, rash, tremor or oedema; reintroduce at 50mg/day.

• Treat with full dose warfarin or LMW heparin if thromboembolic event. Stop thalidomide and restart at 50mg/day escalating on the subsequent cycle to 100mg/day.

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