BMT Drug Side Effects Flashcards
What is CBV (cyclophosphamide, BCNU, etoposide) used for?
Auto- SCT for lymphproliferative disorders.
What is Bu/Cy (BCNU, Etoposide, Ara-C, Melphalan) used for?
- Allo SCT
- Auto SCT for AML
What is BEAM 868 used for?
Auto SCT for NHL and HL
What is Melphelan Regimen used for? What is LOS?
Only Myeloma.
LOS: leave after engraftment, generally 14d after infusion
What is Flu/Bu and what used for?
Allo SCT, both RIC and high-dose conditioning
Carmustine/BCNU hypersensitivity reaction:
due to EtOH:
- HA
- Facial tingling
- Bronchospasm, dyspnea
- Diaphoresis
- Urticaria, rash
- Tachycardia, HOTN
What to give for carmustine/BCNU hypersensitivity reaction?
Pepcid, Benedryl, +/- steroids
BCNU drug interactions
digoxin, ampho B
BCNU organ toxicities
pulm, renal, can have LFT abnormalities
Melphalan SE
- mucositis (use cryotherapy!)
- orthostasis, autonomic dysfunction (MWF ortho vitals)
- highly emetogenic (day of admin, day after)
- diarrhea
Etoposide acute SE
- *Give w/ fluids**
- orthostasis
- hypersensitivity (inclu. angioedema)
- metallic taste during infusion
- radiation recall (severe sunburn-like effect)
Etoposide chronic SE
- secondary AML
Cytarabine
Allergic type, w/in 12 hours infusion: - rash - flu-like sx - bone pain - conjunctivitis - CP Also... - noncardiogenic pulm edema - neurotox (cerebellar, etc) but generally only w high dose
Cytarabine drug interaction
Digoxin
LOS for BEAM?
Leave after engraftment, generally 14d after infusion
What is 898 and who used for?
Thiotepa, Busulfan, Cytoxan
+Keppra and Mesna
Used for CNS lymphoma
Thiotepa SE
PROFOUND RASH.
- urticaria, bronzing, flaking, desquamation
–> Nursing to do: showers/linen change twice daily, no moisturizers
NEUROTOX.
- confused, ST mem, motor function
MUCOSITIS.
- should get kepivance PTA, days 0-2
Bulsulfan SE:
- neurotoxicity (Keppra ppx til day -1)
- N/V/D, mucositis
- skin hyperpigmentation
- busulfan lung = intersitital pneumonitis
Busulfan drug interaction:
Tylenol (avoid 72h prior and after), will increase bu toxicity
Cytoxan SE:
- hemorrhagic cysititis (goal UOP 200cc/hr)
- URI-like sx
Cytoxan late SE:
- Secondary AML
- Secondary bladder cancer
898 LOS
14d after engraftment techinically… but often longer. Patients will get sick (rash, high fevers, confusion)
896 (Carboplatin, etoposide) what is it used for:
“Tandem autoSCT” Given for germ cell tumors and testicular Ca
Carboplatin SE:
- Hypersensitivity (typically rash, urticaria only)
- peripheral neuropathy
- renal tox
- transient LFT abnormality (particularly alk phos)
855 RIC (Flu/Bu with Tac/Rap/MTX) who gets it
alloSCT for lymphoma who failed autos
Fludarabine SE:
- mild N/V, fever, flu-like sx
- maculopapular rash
- transient transaminitis
LOS for 855 RIC
~5 days, normal leave after day +1 MTX
What med to add for 855 RIC (flu/bu, tac/rap/mtx) if hx liver issues?
Actigall
886 (flu/mel with tac/rap/mtx) indication
moderate intensity conditioning for alloSCT in AML/MDS who can’t tolerate full intensity
TBI SE
- worsening nausea
- worsening mucositis
- hyperpigmentation
Goal tac level
5-10
Goal rap level
3-12
General time to engraft PBSCT
14d
General time to engraft BMT
21d
Since marrow products have heparin, hold ___?
AC (lovenox etc)
What info to always put in note for allo BMT patients
- related/unrelated
- ABO mismatch status
- CMV and toxo status
- Peripheral vs marrow cells
- Include pre-BMT workup as resolved problem in all notes
How to manage toxo positive patient
Toxo PCR 0,7,14
Bactrim (as opposed to Mepron) on discharge
