Protocol for using monthly IV CYC
There are many different protocols that can be used. The following is one example:
- a) Prior to CYC
- • Premedication 15–30 minutes prior to CYC: dexamethasone 10 mg, lorazepam 1 mg, and ondansetron (Zofran) 8 mg or ganisetron (Kytril) 1 mg in 100 cc normal saline IV
- • Mesna (25% of CYC dose in milligrams) in 250 cc normal saline
- b) CYC infusion
- • CYC 0.5–1.0 g/m 2 of body surface area in 1000 cc normal saline for initial dose. If creatinine clearance is less than 35–40 cc/minute, then start initial dose at 0.50 g/m 2 of bovine serum albumin. If on dialysis, give 0.4–0.5 g/m 2 8–10 hours before or after dialysis.
- • Subsequent monthly doses depend on WBC counts at 10 to 14 days post CYC.
- • If nadir < 3000/mm 3 , reduce dose by 0.25 g/m 2
- • If nadir > 4000/mm 3 , dose can be increased if necessary to maximum of 1 g/m 2
- • Consider the use of gonadotropin-releasing hormone (Lupron) 3.75 mg intramuscularly (IM) 10 days prior to each of the monthly CYC dose or testosterone supplementation (200 mg IM every 2 weeks) for men to prevent premature gonadal failure from longstanding therapy (data is limited).
- c) Post CYC infusion
- • Mesna (25% of CYC dose in mg) in 250 cc normal saline
- • Compazine SR 15 mg twice a day as needed or compazine 10 mg thrice a day (TID) as needed for 2–3 days
- d) Dose interval for CYC
- • Monthly for 6 doses, then
- • Maintenance with AZA or MMF