Cyclophosphamide + PE Rx

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PLASMA EXCHANGE + IV CYCLOPHOSPHAMIDE PROTOCOL

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.
- This includes:
  - 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.
Blood tests: Obtained before the first plasma exchange and at intervals thereafter.
- Heme-8, differential, platelets (every month)
- Comprehensive metabolic panel (CPT code 80053) (every month)
- IgM vs GM1 or MAG (every 3 to 4 months): Send to
Follow-up - Return outpatient appointment is 1 to 2 months after the last treatment.
Nursing precautions should include:
- Double gloving on handling urine because Cytoxan is excreted in the urine.
- Double gloving when spiking Cytoxan mini bottles.
- Post dose disposal of empty bottle in red bag.

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8/8/2001