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Home > HSCT Allogeneic conditioning Reduced intensity Haploidentical - Mel/Flu/TBI 2Gy with PTCy [melphalan, fludarabine and total body irradiation 2Gy with post-transplant CYCLOPHOSPHamide]

HSCT Allogeneic conditioning Reduced intensity Haploidentical - Mel/Flu/TBI 2Gy with PTCy [melphalan, fludarabine and total body irradiation 2Gy with post-transplant CYCLOPHOSPHamide]

Treatment Overview

Cycle 1 - 35 days

Cycle length:
35

Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.


melphalan:

  • Consider oral cryotherapy on Day -6 by giving patient ice to suck starting 15 minutes prior to, during and up to one hour after the melphalan infusion.
  • The total time from preparation to the completion of the infusion should not exceed 90 minutes.

CYCLOPHOSPHamide:

  • Dose adjustment for patients weight may be required.
  • See Dosing for bodyweight in Additional details.
  • Refer to latest literature or access https://anztct.org.au (registration required).
  • Monitor for syndrome of inappropriate secretion of ADH with high dose CYCLOPHOSPHamide.

mycophenolate mofetil:

  • Maximum dose of 3000 mg (3 g) per day.
  • Continue until Day 35, then stop.

ciclosPORIN:

  • Adjust dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for graft versus host disease (GVHD) prophylaxis to be continued, duration as per haematologist advice.

Cycle details

Cycle 1 - 35 days

Medication / Procedure Dose Route Days Max Duration
sodium chloride 0.9 % intravenous -6 120 minutes
melphalan 140 mg/m² intravenous -6 30 minutes
sodium chloride 0.9 % intravenous -6 120 minutes
fludarabine * 40 mg/m² Once daily intravenous -5 to -2 30 minutes
Total body irradiation 2 Gy -1
paracetamol * 1000 mg flat dosing oral administration 0
proMETHazine * 12.5 mg intravenous 0 1 minutes
Allogeneic stem cell transplant intravenous 0
mesna * 50 mg/kg Once daily intravenous 3, 4 24 hours
sodium chloride 0.9 % intravenous 3, 4 120 minutes
CYCLOPHOSPHamide * 50 mg/kg Once daily intravenous 3, 4 120 minutes
sodium chloride 0.9 % intravenous 3, 4 120 minutes
mycophenolate mofetil * 15 mg/kg Three times daily oral administration 5 to 35
ciclosPORIN * 1.5 mg/kg Twice daily intravenous 5 to 8 Min: 120 minutes
ciclosPORIN * [Dose - see details] Twice daily intravenous 9 to 35 Min: 120 minutes

Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.


melphalan:

  • Consider oral cryotherapy on Day -6 by giving patient ice to suck starting 15 minutes prior to, during and up to one hour after the melphalan infusion.
  • The total time from preparation to the completion of the infusion should not exceed 90 minutes.

CYCLOPHOSPHamide:

  • Dose adjustment for patients weight may be required.
  • See Dosing for bodyweight in Additional details.
  • Refer to latest literature or access https://anztct.org.au (registration required).
  • Monitor for syndrome of inappropriate secretion of ADH with high dose CYCLOPHOSPHamide.

mycophenolate mofetil:

  • Maximum dose of 3000 mg (3 g) per day.
  • Continue until Day 35, then stop.

ciclosPORIN:

  • Adjust dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for graft versus host disease (GVHD) prophylaxis to be continued, duration as per haematologist advice.

Full details

Cycle 1 - 35 days

Day: -6

Medication Dose Route Max duration Details
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

Prior to melphalan infusion.
melphalan 140 mg/m² intravenous 30 minutes
Instructions:
  • Consider oral cryotherapy by giving patient ice to suck starting 15 minutes prior to, during and up to one hour after the melphalan infusion.
  • The total time from preparation to the completion of the infusion should not exceed 90 minutes.
Additional details:
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

After melphalan infusion.

Day: -5

Medication Dose Route Max duration Details
fludarabine * 40 mg/m² Once daily intravenous 30 minutes Additional details:

Day: -4

Medication Dose Route Max duration Details
fludarabine * 40 mg/m² Once daily intravenous 30 minutes Additional details:

Day: -3

Medication Dose Route Max duration Details
fludarabine * 40 mg/m² Once daily intravenous 30 minutes Additional details:

Day: -2

Medication Dose Route Max duration Details
fludarabine * 40 mg/m² Once daily intravenous 30 minutes Additional details:

Day: -1

Medication / Procedure Dose Route Max duration Details
Total body irradiation 2 Gy
Instructions:

Administer as per institutional practice.

Day: 0

Medication / Procedure Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:

ONE hour prior to return of allogeneic stem cells, or as per institutional practice.
proMETHazine * 12.5 mg intravenous 1 minutes
Instructions:

ONE hour prior to return of allogeneic stem cells, or as per institutional practice.
Allogeneic stem cell transplant intravenous
Instructions:

Administer as per institutional practice.

Day: 3

Medication Dose Route Max duration Details
mesna * 50 mg/kg Once daily intravenous 24 hours
Instructions:

Continuous infusion over 24 hours.

  • Commence ONE hour before the first dose of CYCLOPHOSPHamide and continue for 24 hours after the last dose of CYCLOPHOSPHamide, or as per institutional practice.
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

Prior to CYCLOPHOSPHamide infusion.
CYCLOPHOSPHamide * 50 mg/kg Once daily intravenous 120 minutes
Instructions:
  • Dose adjustment for patients weight may be required, see Dosing for bodyweight, below.
  • Consider hydration in addition to that specified to achieve 3000 ml/m2/24 hours is recommended on days of high dose CYCLOPHOSPHamide and for 24 hours after, or as per institutional practice.


Additional details:
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

After CYCLOPHOSPHamide infusion.

Day: 4

Medication Dose Route Max duration Details
mesna * 50 mg/kg Once daily intravenous 24 hours
Instructions:

Continuous infusion over 24 hours.

  • Commence ONE hour before the first dose of CYCLOPHOSPHamide and continue for 24 hours after the last dose of CYCLOPHOSPHamide, or as per institutional practice.
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

Prior to CYCLOPHOSPHamide infusion.
CYCLOPHOSPHamide * 50 mg/kg Once daily intravenous 120 minutes
Instructions:
  • Dose adjustment for patients weight may be required, see Dosing for bodyweight, below.
  • Consider hydration in addition to that specified to achieve 3000 ml/m2/24 hours is recommended on days of high dose CYCLOPHOSPHamide and for 24 hours after, or as per institutional practice.


Additional details:
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

After CYCLOPHOSPHamide infusion.

Day: 5

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * 1.5 mg/kg Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Adjust dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.

Day: 6

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * 1.5 mg/kg Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Adjust dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.

Day: 7

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * 1.5 mg/kg Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Adjust dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.

Day: 8

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * 1.5 mg/kg Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Adjust dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.

Day: 9

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 10

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 11

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 12

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 13

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 14

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 15

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 16

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 17

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 18

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 19

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 20

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 21

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 22

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 23

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 24

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 25

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 26

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 27

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 28

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 29

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 30

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 31

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 32

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 33

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 34

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Maximum 3000 mg (3 g) per day.

  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued, duration as per haematologist advice.

Day: 35

Medication Dose Route Max duration Details
mycophenolate mofetil * 15 mg/kg Three times daily oral administration
Instructions:

Stop after Day 35.

  • Maximum 3000 mg (3 g) per day.
  • Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ciclosPORIN * [Dose - see details] Twice daily intravenous Min: 120 minutes
Instructions:

Every 12 hours.

  • Dose according to trough levels as per institutional practice.
  • Switch to oral therapy when tolerated, ensure correct conversion between IV and oral therapy.
  • Oral ciclosPORIN for GVHD prophylaxis to be continued past day 35, duration as per haematologist advice.

Additional details

Section 1: Dosing for bodyweight

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for hepatitis B virus: Required for anti–HBc positive patients at risk of reactivation
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
CMV monitoring: Recommended
Emetogenicity: Variable
Gastroprotection: Gastroprotection may be considered
Graft versus host disease prophylaxis: Graft versus host disease prophylaxis is mandatory
Hydration: Routine hydration recommended
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Irradiated blood components: Irradiation of blood components is recommended
Mesna uroprotection: Routine mesna uroprotection recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Sinusoidal obstruction syndrome prophylaxis: Sinsuoidal obstruction prophylaxis may be considered
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

Antifungal prophylaxis: Inhibition of CYP3A4 by azole antifungals will lead to reduced ciclosPORIN clearance and increased toxicities. A reduced ciclosPORIN dose is required with close monitoring of ciclosPORIN levels—see prescribing information, or Interactions checker in the NZ Formulary (nzf.org.nz).


CMV monitoring:

  • If allograft recipient +/- donor are CMV seropositive:
  • CMV quantitative PCR monitoring of CMV viral load should commence day 14 and be repeated once a week.
  • Evidence of CMV reactivation necessitates appropriate antiviral treatment. 

Emetogenicity:

  • MINIMAL day -5, -4, -3, and -2;
  • HIGH days -6, +3 and +4;
  • Radiotherapy-induced nausea and vomiting (RINV) day -1.

 

References

Brammer JE, Khouri I, Gaballa S, Anderlini P, Tomuleasa C, Ahmed S, Ledesma C, Hosing C, Champlin RE, Ciurea SO. Outcomes of Haploidentical Stem Cell Transplantation for Lymphoma with Melphalan-Based Conditioning. Biol Blood Marrow Transplant. 2016 Mar;22(3):493-8. doi: 10.1016/j.bbmt.2015.10.015. Epub 2015 Oct 20., PMID: 26497906

Epperla N, Pasquini M, Pierce K, Drobyski WR, Rizzo JD, Horowitz MM, Saber W, Zellner K, Ramirez S, Bartz K, Raj RV, Hari PN, Hamadani M. Salvage haploidentical hematopoietic cell transplantation for graft rejection following a prior haploidentical allograft. Bone Marrow Transplant. 2017 Jan;52(1):147-150. doi: 10.1038/bmt.2016.200. Epub 2016 Aug 1., PMID: 27479688

Gifford G, Wong K, Kerridge I, Stevenson W, Arthur C, Fay K, Greenwood M. Addition of low dose total body irradiation to fludarabine melphalan reduced intensity conditioning is feasible, tolerable, and may improve outcomes in patients with high-risk acute myeloid leukaemia and other high risk myeloid malignancies. Am J Hematol. 2015 May;90(5):E97-100. doi: 10.1002/ajh.23974. Epub 2015 Mar 2., PMID: 25683457

Bubalo J, Carpenter PA, et al; American Society for Blood and Marrow Transplantation practice guideline committee. Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee. Biol Blood Marrow Transplant. 2014 May;20(5):600-16. doi: 10.1016/j.bbmt.2014.01.019. Epub 2014 Jan 23., PMID: 24462742

New Zealand Blood Service Transfusion Medicine Handbook Third Edition, 2016 https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111G122.pdf (accessed 16 June 2022)

Nakagaki M, Button E, Keating A, Marsh J, Mitchell C, Birchley A, Kennedy GA. Hyperhydration is not necessary for high-dose melphalan in stem cell transplantation. Bone Marrow Transplant. 2020 Apr;55(4):827-829. doi: 10.1038/s41409-019-0586-1. Epub 2019 Jun 11., PMID: 31186515

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.