Cytotoxic Schedules and Choice of Antiemetics

Highly Emetogenic (HEC)

Aprepitant 125 mg PO on day one, 80 mg on day 2, day 3 after the highly emetogenic component of any combination chemotherapy.

Ondansetron 8 mg BD PO/IV on days of HEC.

Dexamethasone 12 mg PO/IV once daily until 2 days after HEC.

± Domperidone 10 mg PO four times a day PRN

± Lorazepam 0.5-2 mg PO

Moderately Emetogenic (MEC)

Ondansetron 8 mg BD PO/IV on days of MEC.

Dexamethasone 8 mg PO/IV daily until 2 days after MEC (avoid in AML first line).

± Domperidone 10 mg PO four times a day PRN

± Lorazepam 0.5-2 mg PO.

Low Emetogenic (LEC)

Ondansetron 8-16 mg PO (or 8 mg IV) on day one.

Dexamethasone 8 mg PO once on day one.

± Metoclopramide or Domperidone 10 mg PO four times a day PRN.

Cytotoxic Schedule

Choice of Antiemetic Protocol (HEC, MEC, or LEC)

Standard Allograft SCT Conditioning

Cy/TBI - use HEC protocol throughout.
Bu/Cy - use HEC protocol on cyclophosphamide days and for 2 days after. Use LEC protocol on other days.

RIC Allo SCT Conditioning

Flu/Mel/Alemtuzumab - use LEC on each day of fludarabine. Use MEC protocol starting on the day of melphalan.

Standard Autologous Conditioning

BEAM - use HEC protocol on day -6 to -4 then MEC protocol day -4 to day +1.
High Dose Melphalan - use MEC protocol day -1 to day +1.

Cyclophosphamide for Stem Cell Harvest

Use MEC protocol.

AML (DA, ADE, HDAC, FLAG, Ida-Cytarabine, MiDAC)

Use MEC protocol without dexamethasone first line.

CHOP

Use MEC protocol (without dexamethasone as CHOP contains high dose prednisone).

ICE

Use LEC on day 1 of chemo.
Use MEC from day 2 onwards (when carboplatin starts).

Hyper CVAD and MTX-Cytarabine

Use MEC protocol.

CODOX-M Regimen

Use MEC protocol day 1-12.

IVAC

Use MEC protocol day 1-7.

High dose Methotrexate

Use MEC protocol.

UKALL12 Induction 1

Use the 3 day MEC protocol (without dexamethasone as high dose prednisone is being given) starting each time with daunorubicin on day 1,8,15,22.

UKALL12 Induction 2

Use 3 day MEC protocol starting with each cylophosphamide on days 1,15,29.
Use LEC protocol on other days.

Note: Chemotherapy charts include both the cytotoxic drugs used plus the appropriate antiemetic supportive care required.


About this Canterbury DHB document (9327):
Document Owner:	Sean Macpherson (see Who's Who)
Last Reviewed:	January 2019
Next Review:	January 2022
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
Send Feedback Send Feedback	Expand All Drop-downs

Topic Code: 9327