Utility: This protocol is for use in patients with motor and anti-MAG neuropathies.
Treatment regimen: During each cycle of treatment patients receive
plasma exchange (1.5 plasma volumes) with 5% albumin replacement on two consecutive days.
This is followed by hydration (1 to 1.5 liters), then 1g/M2 of
cyclophosphamide given intravenously over 3 to 4
hours, and, finally, further hydration (1 to 1.5 liters).
During a course of therapy this regimen is given 6 times, one every 4 weeks.
The patient is treated with cyclophosphamide (Cytoxan), a total of 1.0 gm/M2
intravenously over a period of 3 hours. Patients should be otherwise healthy and without
evidence of infection for the prior 1-2 weeks. The protocol should probably be modified
in debilitated patients.
Precautions taken to avoid side effects include:
Fluid: Administration of 3-4 liters of fluid on the days of Cytoxan treatment.
1-1.5 liters of fluid before Cytoxan treatment
Fluid administered with Cytoxan treatment
The remainder of the fluid to be administered after Cytoxan treatment.
The IV fluid should be D5 0.5 NS administered at up to 150 cc/M2/hour.
Fluid load should be modified for patients with abnormal cardiac function or who are otherwise debilitated.
Some of the post-treatment IV fluid may be replaced by p.o. intake.
Antiemetics - Zofran (Ondansetron) 0.15 mg/kg over 15 minutes: Give
Prophylactically beginning 30 minutes prior to each cyclophosphamide dose
4 and 8 hours after treatment
The patient should be sent home with enough antiemetics for 2-3 days.
Strict I&O should be kept during the patient's hospital stay.
Urine: During and 1 day after treatment
All urine should be evaluated for heme.
Microscopic analysis of the urine should be performed after each medication dose.
The specific gravity on all urines should be determined.
After administration of Cytoxan, IV tubing should be changed before resuming
regular IV hydration.
Obtained before the first plasma exchange and at intervals thereafter.