MITCHELL BINDA

MRN: 27-65-75
DOB: 2005
DIAGNOSIS: Burkitts Lymphoma
Chemotherapy regimen: Each cycle consists of 6 weeks of inpatient treatment with 1 week
breaks in between. He may need any where from 3 to 6 cycles.
Baseline Labs: CBC with differential, ALT, AST, Total bilirubin, BUN/creatinine, electrolytes (Na, K,
Cl, CO2)
WEEK

DAY

Medication

Allopurinol
IVF/bicarb
Allopurinol
Cyclophosphamide
1200mg/m2 (IV)
Hydrocortisone
Septrin

2
3

10

Allopurinol
Methotrexate
Septrin
Allopurinol
Methotrexate
Prednisone
Septrin
Methotrexate
Prednisone
Septrin
IVF/bicarb
Methotrexate
Prednisone
Septrin
IVF/bicarb
Methotrexate
Prednisone
Septrin
IVF/bicarb
Methotrexate
Prednisone
Septrin
IVF/bicarb
Methotrexate
Prednisone
Septrin
IVF/bicarb
Methotrexate
Prednisone
Septrin
IVF/bicarb
Methotrexate
Prednisone
Septrin
IVF/bicarb

Labs

Precautions/Monito
ring
Q 4hr vitals and
urine output
measurement

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
CBC,
electrolytes

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement

11

12

13
3

14
15

16
17

Methotrexate
Prednisone
Septrin
IVF/bicarb
Methotrexate
Prednisone
Septrin
IVF/bicarb
Prednisone
Septrin
IVF/bicarb
Prednisone
Septrin
IVF/bicarb
Cyclophosphamide
750 mg/m2 (po)
Methotrexate
Prednisone
Septrin
IVF/bicarb
Prednisone
Septrin
IVF/bicarb
Prednisone
Septrin

18

Prednisone
Septrin

19

Prednisone
Septrin

20

Prednisone
Septrin

21

Prednisone
Septrin
IVF/bicarb
Cyclophosphamide
750 mg/m2 (po)
Methotrexate
Prednisone
Septrin
IVF/bicarb
Prednisone
Septrin
IVF/bicarb
Prednisone
Septrin

22

23
24
25

Prednisone
Septrin

26

Prednisone
Septrin

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement

CBC with
chemistry

CBC with
chemistry

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output

27

Prednisone
Septrin

28

Prednisone
Septrin
IVF/bicarb
Cyclophosphamide
750 mg/m2 (po)
Methotrexate
Prednisone
Septrin
IVF/bicarb
Prednisone
Septrin
IVF/bicarb
Prednisone wean
Septrin

29

30
31

32

Prednisone wean
Septrin

33

Prednisone wean
Septrin

34

Prednisone wean
Septrin

35

Prednisone wean
Septrin

36

Cyclophosphamide
750 mg/m2 (po)
Methotrexate
Prednisone
Septrin
IVF/bicarb
Prednisone wean
Septrin
IVF/bicarb
Prednisone wean
Septrin
(consider discharge)
Prednisone wean
Septrin

37
38
39
40

Prednisone wean
Septrin

41

Prednisone wean
Septrin

42

Prednisone wean
Septrin

CBC with
chemistry

CBC with
chemistry

measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement

Q 4hr vitals and

urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement
Q 4hr vitals and
urine output
measurement

43

Discharge home for

one week on Septrin

Q 4hr vitals and

urine output
measurement

Medication Doses
1. Cyclophosphamide 1200mg/m2 (IV) in week 1 then 750mg/m2 (PO) from week 2
2. Methotrexate: 30mg/m2 x 5 days, then weekly for 5 weeks
3. Allopurinol: 10mg/kg/day divided BID (max daily dose 800mg)
4. Prednisone: 40mg/m2/day divided TID for four weeks, then wean over two weeks
5. Septrin (PCP prophylaxis throughout treatment): 10mg/kg/day divided BID
6. IVF: D5NS with 35meq sodium bicarbonate per 500ml running at 1.5x maintenance
Chemotherapy:
Oral Cyclophosphamide available from Chariff Pharmacy on Randall Street
Cost US$$9 for blister strip (10x 50mg tablets)
IV Cyclophosphamide available from Itter Pharmacy on Benson Street
Cost: US $35/500mg
Additional Medications
1. Metoclopramide: 0.2mg/kg/dose IV up to QID prn nausea/vomiting
2. Gentian Violet (apply weekly as needed for mucositis)
3. Omeprazole (while on Prednisone): 1mg/kg po daily
4. Lactulose: 7.5ml (5g) daily po after breakfast as needed for constipation (10g/15ml)
5. Oral Nystatin:5ml (swish and swallow or apply to oral mucosa) 3x/day
6. Normal saline (for mouth cleaning) 3x/day
7. Ampicillin and Gentamicin for fever >38
Notes:
1. Goal urine output: 4-6cc/kg/hr throughout treatment.
2. If weekly CBC reveals ANC (granulocyte count) is less than 500 x 10 6/L, delay
chemotherapy until ANC is greater than 500.
3. If electrolyte/hematologic abnormalities cause delays in the administration of
cyclophosphamide or methotrexate, the regimen must be moved back the same number
of days.