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IV CYCLOPHOSPHAMIDE PROTOCOL

• Hydration (1 to 1.5 liters)
• Then 1g/M² of cyclophosphamide given intravenously over 3 to 4 hours
• Further hydration (1 to 1.5 liters).

• 6 times, one every 4 weeks.
• Each treatment: 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

1. 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.
2. 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.
     
3. Strict I&O should be kept during the patient's hospital stay.
4. 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.
     
5. After administration of Cytoxan, IV tubing should be changed before resuming regular IV hydration.
   
6. Blood tests: Obtained before the first treatment and at intervals thereafter.
   • Heme-8, differential, platelets (every month)
   • Comprehensive metabolic panel (every month)
   • IgM: Quantitative levels
   • IgM vs GM1 or MAG (every 3 to 4 months): Send to
     Neuromuscular Clinical Laboratory
     Box 8111 - Neurology
     660 South Euclid Avenue
     St. Louis, MO 63110
     Phone: 314-362-6981
     Fax: 314-362-2826
     
7. Follow-up - Return outpatient appointment is 1 to 2 months after the last treatment.
   
8. 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 container.

• Quantitative dynamometry (Muscle strength, distal & proximal): Every 3 months
• Quantitative sensory testing: RS tuning fork at toes, ankles, knees & fingers
• Gait testing: Tandem gait up to 8 steps