Canterbury DHB

Context

Prescription Charts

The following chemotherapy charts are given here and the supportive care recommended for each protocol is also given. See also Drug Usage and Prescribing in Haematology, Cytotoxic Drugs.

For drug trial charts, see the Clinical Trials page on the Intranet.

In This Section

Individualised Template

Aplastic Anaemia

Acute Lymphoblastic Leukaemia

Acute Myeloid Leukaemia

Chronic Lymphocytic Leukaemia

Hairy Cell Leukaemia

Intrathecal Chemotherapy

MDS

Myeloma

Non Hodgkin Lymphoma

Rituximab - any indication

Waldenstroms

Oral Chemo Templates

Supportive Care Sheets

Individualised Template

If an authorised template for the regimen is not available, the individualised template may be used to create the required regimen. DO NOT alter authorised templates.

 

Prescription Chart

Individualised template

Word

Aplastic Anaemia

 

Prescription Chart

Atgam Equine

Word | PDF

Acute Lymphoblastic Leukaemia

UKALL 14

Prescription Chart

Induction 1

Word | PDF

Induction 2

Word | PDF

Intensification

Word | PDF

Consolidation 1

Word | PDF

Consolidation 2

Word | PDF

Consolidation 3

Word | PDF

Consolidation 4

Word | PDF

Maintenance

Word | PDF

UKALL12

Prescription Chart

Induction Phase 1

Word | PDF

Induction Phase 2

Word | PDF

Intensification

Word | PDF

IT Cytarabine with radiation

Word | PDF

Consolidation Phase 1

Word | PDF

Consolidation Phase 2

Word | PDF

Consolidation Phase 3

Word | PDF

Consolidation Phase 4

Word | PDF

Maintenance

Word | PDF

Other Treatments for ALL

 

Lymphoblastic lymphoma hyper-CVAD

Word | PDF

Lymphoblastic lymphoma MTX cytarabine

Word | PDF

Modified Opal with L-Asparaginase

Word | PDF

Modified Opal

Word | PDF

Vincristine single dose

Word | PDF

See the Intrathecal Chemotherapy Medication Chart.

Acute Myeloid Leukaemia

See AML 19 Trial Information.

AML19 Trial

Prescription Chart

Irradiated Blood
Products Alert form

D(60)A 3+10 with gemtuzumab (arm A)

Word | PDF

 

D(60)A 3+10 with gemtuzumab x2 (arm B)

Word | PDF

 

FLAG-Ida with gemtuzumab (arm A)

Word | PDF

 

FLAG-Ida with gemtuzumab x2 (arm B)

Word | PDF

 

D(50)A 3+8 Course 2

Word | PDF

 

FLAG-Ida Course 1 (no gemtuzumab)

Word | PDF

 

FLAG-Ida Course 2

Word | PDF

 

High dose cytarabine

Word | PDF

 

Fludarabine + CPX-351 C1

Word | PDF

 

Fludarabine + CPX-351 C2

Word | PDF

 

Fludarabine + CPX-351 C3

Word | PDF

 

MACE

Word | PDF

 

MidAC

Word | PDF

 

CPX-351 Course 1

Word | PDF

 

CPX-351 Course 2

Word | PDF

 

CPX-351 Course 3 or 4

Word | PDF

 

AML 19 trial – APML patients

Prescription Chart

Irradiated Blood
Products Alert form

AIDA induction

Word | PDF

 

AIDA consolidation 1

Word | PDF

 

AIDA consolidation 2

Word | PDF

 

AIDA consolidation 3

Word | PDF

 

AML17 Trial (old charts)

Prescription Chart

Irradiated Blood
Products Alert form

Induction (1) D(60)A 3 + 10

Word | PDF

 

Other Treatments for AML

Prescription Chart

Irradiated Blood
Products Alert form

Low Dose Cytarabine

Word | PDF

 

IDA / Cytarabine

Word | PDF

 

Non-trial treatments for APML

Prescription Chart

Irradiated Blood
Products Alert form

ATRA Script

Word | PDF

 

Induction 1 - Tretinoin with Arsenic Trioxide

Word | PDF

 

Induction 2 - Tretinoin with Arsenic Trioxide

Word | PDF

 

Consolidation - Tretinoin with Arsenic Trioxide

Word | PDF

 

UKAML15 (old charts)

Prescription Chart

Irradiated Blood
Products Alert form

DA 3 + 10 - Course 1

Word | PDF

 

Chronic Lymphocytic Leukaemia

 

Prescription Chart

Irradiated Blood
Products Alert form

Rituximab + Bendamustine Cycle 1

Word | PDF

PDF

Rituximab + Bendamustine Cycles 2 +

Word | PDF

PDF

Fludarabine

Word | PDF

PDF

Fludarabine/Cyclophosphamide

Word | PDF

PDF

Alemtuzumab initiation SC

Word | PDF

 

Alemtuzumab maintenance SC

Word | PDF

 

Alemtuzumab IV

Word | PDF

 

Rituximab/Cyclo/Fludarabine 375 IV

Word | PDF

PDF

Rituximab/Cyclo/Fludarabine 375 PO

Word | PDF

PDF

Rituximab/Cyclo/Fludarabine 500 IV

Word | PDF

PDF

Rituximab/Cyclo/Fludarabine 500 PO

Word | PDF

PDF

Rituximab 375

Word | PDF

 

Methylprednisolone

Word | PDF

 

Obinutuzumab + chlorambucil Cycle 1

Word | PDF

 

Obinutuzumab + chlorambucil Cycle 2 onwards

Word | PDF

 

Hairy Cell Leukaemia

 

Prescription Chart

Irradiated Blood
Products Alert form

Cladribine - daily

Word | PDF

PDF

Cladribine - weekly

Word | PDF

PDF

Intrathecal Chemotherapy

 

Prescription Chart

Intrathecal Chemotherapy

Word | PDF

MDS

 

Prescription Chart

Azacitidine

Word | PDF

Myeloma

 

Prescription Chart

Pamidronate Chart

Oral Prescriptions

Patient Information Leaflet

CyBorD

Word | PDF

PDF

Word | PDF

Word | PDF

Consolidation VTD post Auto SCT

Word | PDF

PDF

Word | PDF

 

VMP weekly - modified VISTA

Word | PDF

PDF

Word | PDF

 

Bortezomib alone

Word | PDF

PDF

Word | PDF

 

Non Hodgkin Lymphoma

 

Prescription Chart

Irradiated Blood
Products Alert form

Oral Prescriptions

Patient Information Leaflet

R-CVP

Word | PDF

 

Word | PDF

Word | PDF

R-CHOP

Word | PDF

 

Word | PDF

Word | PDF

Rituximab + Bendamustine

Word | PDF

PDF

 

 

Mini R-CHOP

Word | PDF

 

 

 

Inpatient DA-R EPOCH

Word | PDF

 

 

 

Outpatient DA-R-EPOCH Cycle 1

Word | PDF

 

 

 

Outpatient DA-R-EPOCH Cycle 2 +

Word | PDF

 

 

 

R-Hyper-CVAD

Word | PDF

 

 

 

R-MTX Ara-C

Word | PDF

 

 

 

CNS Prophylaxis – High Dose Methotrexate

Word | PDF

 

 

 

R-CEOP

Word | PDF

 

 

 

Rituximab 375

Word | PDF

 

 

 

Mantle Cell Lymphoma

Mantle Cell R Maxi-CHOP

Word | PDF

 

 

 

Mantle Cell R High Dose Cytarabine

Word | PDF

 

 

 

Mantle Cell R-BAC

Word | PDF

 

Word | PDF

Word | PDF

Relapsed/Refractory Lymphoma

R-ICE

Word | PDF

 

 

R-GDP

 

 

 

Vinorelbine and gemcitabine

Word | PDF

Word | PDF

 

Burkitt-type Lymphoma

CODOX-M - patients all ages

Word | PDF

 

 

 

R IVAC - patients 65 years or less

Word | PDF

 

 

 

R IVAC - patients over 65

Word | PDF

 

 

 

Hyper-CVAD cycles 5 and 7

Word | PDF

 

 

 

MTX cytarabine cycles 6 and 8

Word | PDF

 

 

 

Ritux  hyper-CVAD cycles 1 and 3

Word | PDF

 

 

 

Ritux MTX cytarabine cycles 2 and 4

Word | PDF

 

 

 

* There are currently no prescription sheets for these protocols. If they are required, please page the Haematology Pharmacist on 8209.

Rituximab - any indication

 

Prescription Chart

Rituximab weekly 100

Word | PDF

Rituximab weekly 375

Word | PDF

Rituximab 375

Word | PDF

Waldenstroms

 

Prescription Chart

Rituximab cladribine daily SC

Word | PDF

Rituximab, Cyclophosphamide PO, Dex

Word | PDF

Rituximab and Oral Fludarabine

Word | PDF

About this Canterbury DHB document (10276):

Document Owner:

Steve Gibbons and Fiona Stone (see Who's Who)

Issue Date:

March 2017

Next Review:

March 2020

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 10276