NECN CHEMOTHERAPY HANDBOOK PROTOCOL

ABCM (Multiple Myeloma)

DRUG ADMINISTRATION SCHEDULE

Day Drug Dose Route Diluent Rate

Ondansetron 8mg IV bolus
via 0.9% Sodium
1 Doxorubicin 30mg/m2 IV bolus
Chloride Drip
500ml 0.9%Sodium
Carmustine (BCNU) 30mg/m2 IV infusion 1 hour
Chloride
22 to
Cyclophosphamide 100mg/m2 ORAL Once daily For 4 days
25
22 to
Melphalan 6mg/m2 ORAL Once Daily For 4 days
25

CYCLE LENGTH AND NUMBER OF DAYS

42 Day cycle, usually given for a maximum of 6 cycles

APPROVED INDICATIONS
Multiple Myeloma
Mantle cell lymphoma

ELIGIBILITY CRITERIA

EXCLUSION CRITERIA

RECOMMENDED TAKE HOME MEDICATION

Allopurinol 300mg once daily with first cycle of treatment
Ondansetron 8mg twice daily for 2 days after doxorubicin.
Metoclopramide 10mg three times daily if required

INVESTIGATIONS / MONITORING REQUIRED

Prior to first cycle: FBC, U&E’s, LFT’s, Paraprotein

Prior to each cycle: FBC, U&E’s, LFT’s, Paraprotein

ASSESSMENT OF RESPONSE
Paraprotein (serum/urine) every 2 cycles in myeloma patients. Assess symptoms.

REVIEW BY CLINICIAN
Prior to each cycle, unless being reviewed by a Nurse Specialist or Pharmacist under
a locally agreed framework. Minimum consultant review annually.

NURSE / PHARMACIST LED REVIEW

As per locally agreed framework, or under share care with GP. 3 monthly review
when stable.

ABCM NECN protocol CRP08 H020 Page 1 of 3

Date Issued: 20/03/2012 Expiry Date: April 2014
 NECN CHEMOTHERAPY HANDBOOK PROTOCOL
ABCM (Multiple Myeloma)
ADMINISTRATION NOTES
Doxorubucin is cardio-toxic. Lifetime maximum dose is 450 - 550mg/m2.
Patients with pre-existing cardiac disease or previous exposure to
anthracyclines should be considered for ECHO.
Cyclophosphamide is supplied in 50mg tablets – dose should be rounded to
the nearest measurable dose
Melphalan is supplied in 2mg tablets – dose should be rounded to the nearest
measurable dose
Patients should drink 2-3 litres (8 – 12 tumblers) of water on days when taking
cyclophosphamide.
Doxorubicin may discolour urine: red.

TOXICITIES
Common: Myelosuppression (moderate risk), Nausea/Vomiting, Fatigue,
Immunosuppression
Less Common: Flushing, Rash, Allergic Reaction, Pulmonary Toxicity, Cardiac
Toxicity, SiADH, Haemorrhagic Cystitis

DOSE MODIFICATION / TREATMENT DELAYS

Haematological Toxicity:
(Note: where haematological disease is affecting bone marrow function, lower
treatment parameters may be acceptable. This should be clearly documented for the
specific patient.)

Delay treatment on Day 1 and Day 22 if ANC < 1.53 x 109cells/l or PLT < 75 x
109cells/l. (Some clinicians use ANC <1.3.) If patients recurrently have low counts
consider switching to C-Weekly Regimen in myeloma patients.

Patients at risk of fluid overload:

Consider reducing dose (or omission of) dexamethasone in patients with a risk of
fluid overload e.g. patients with cardiac involvement of amyloidosis, or nephrotic
syndrome.

Renal Function:

CrCl Melphalan Dose Cyclophosphamide Dose

> 50 ml/min 100% 100%
30–50ml/min 50% 100%
20-30ml/min 100%
Uncertain. Clinical
10-20ml/min 75%
decision required
<10ml/min 50%

TREATMENT LOCATION
Suitable for administration in chemotherapy day units, under the supervision of
haematology teams from Level 1 – 4 Haematology Services.

ABCM NECN protocol CRP08 H020 Page 2 of 3

Date Issued: 20/03/2012 Expiry Date: April 2014
 NECN CHEMOTHERAPY HANDBOOK PROTOCOL
ABCM (Multiple Myeloma)
REFERENCES:
National Amyloidosis Centre: Intermediate dose intravenous melphalan
treatment used in AL amyloidosis (2003)

Document Control
Document Title: ABCM NECN protocol CRP08 H020
Current
Document No: CRP08 H020 1.1
Version:
Calum Polwart, Network Pharmacist Approval
Author:
NECN Signature*
Date
Approved by: Diane Plews / Ann Lenard 20/03/2012
Approved:
Due for Review: April 2014
Summary of
1.0a ‘Final Version’ Approved
Changes
Protocol reviewed. Cyclophosphamide dose adjustments in renal impairment
1.1
added.

ABCM NECN protocol CRP08 H020 Page 3 of 3

Date Issued: 20/03/2012 Expiry Date: April 2014