Ebook Practical chemotherapy - A multidisciplinary guide: Part 2
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Ebook Practical chemotherapy - A multidisciplinary guide: Part 2
FMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2nisolone)USUAL INDICATIONRelapsed low-grade lymphoma.DOSESFMDFludarabine 25 mg/nr IV* on days 1-3Mitoxantrone lOmg/nr IV on day IDexamethasone 20 mg (total dose) IV' or by mouth on days 1-5FMPFludarabine 25 mg/nf IV* on days 1-3Mitoxantrone 10mg/m" IV on day 1Prednisolone’ 40mg (total dose) by mouth Ebook Practical chemotherapy - A multidisciplinary guide: Part 2 on days 1-5ADMINISTRATIONFludarabine is administered by IV bolus or short IV infusion, and mitoxantrone is administered as a slow IV bolus into a freEbook Practical chemotherapy - A multidisciplinary guide: Part 2
e-running saline infusion. The order of administration of IV drugs is not critical. Dexamethasone (FMD) is administered as a slow IV bolus (over a perFMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2 possible), and prednisolone (FMP) is administered by mouth.Mitoxantrone can cause tissue necrosis following extravasation, and should be administered with appropriate precautions to prevent this from occurring. If there is any possibility that extravasation has occurred, contact a senior member of Ebook Practical chemotherapy - A multidisciplinary guide: Part 2the medical team immediately and follow local procedures for dealing with extravasation incidents.’ Published studies were conducted before fludarabinEbook Practical chemotherapy - A multidisciplinary guide: Part 2
e tablets became available However, it is reasonable to suppose that oral fludarabme at a dose of 40mg/m2/day could be substituted for IV fludarabine FMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2monotherapy).’ Published studies have used IV prednisone. This is not available in the UK. Oral prednisolone is often used as a substitute without any requirement for dose adjustment.188 ▼ FMDANTI-EMETICSLow cmetogenic potential (see local policy). Note that the steroids included in the regimen will Ebook Practical chemotherapy - A multidisciplinary guide: Part 2 have a substantial anti-emetic effect, so no additional steroids should be prescribed.CYCLE LENGTH 28 days.NUMBER OF CYCLES Usually 6.SIDE-EFFECTSBonEbook Practical chemotherapy - A multidisciplinary guide: Part 2
e-marrow suppression, alopecia (relatively low risk of major hair loss), nausea and vomiting, mucositis, neurotoxicity (weakness, agitation, confusionFMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2eported after mitoxantrone administration, but it is less common than with anthracyclines. It seems to be more likely at cumulative doses in excess of 160mg/m2, or lOOmg/nT after previous anthracyclinc therapy. The high-dose steroids that are used in these regimens can cause a variety of side-effect Ebook Practical chemotherapy - A multidisciplinary guide: Part 2s, including euphoria/depression, epigastric discomfort, glucose intolerance, insomnia and psychosis.BLOOD NADIR10-15 days (not well defined - mitoxanEbook Practical chemotherapy - A multidisciplinary guide: Part 2
trone produces an earlier nadir than fludarabine, resulting in a window of several days where the nadir might occur).TTOS REQUIRED•Anti emetics appropFMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2imoxazole (e.g 960 mg three times a week) (2 tablets three times a week) should be prescribed as Pneumocystis carinii pneumonia (PCP) prophylaxis during and for 6-12 months after treatment. This is because of the profound reduction in lymphocyte numbers that is caused by fludarabine. However, it sho Ebook Practical chemotherapy - A multidisciplinary guide: Part 2uld be remembered that a significant number of patients are allergic to sulphonamides, so all patients should be asked about this before prescribing.•Ebook Practical chemotherapy - A multidisciplinary guide: Part 2
Ensure that sufficient dexamethasone (FMD) or prednisolone (FMP) tablets are prescribed to finish the cycle of treatment.•Allopurinol (300 mg by mouthFMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2ation should be given to prescribing a gastroprotective agent (e.g. ranitidine 150 mg by mouth twice a day) for the duration of steroid treatment, in order to prevent gastritis.NOTES TO PRESCRIBERS•Check the FBC prior to giving the go-ahead for chemotherapy. Seek advice if the neutrophil count is <1 Ebook Practical chemotherapy - A multidisciplinary guide: Part 2.5 X 109/L or the platelet count is <100 X 109/L. In a large trial of FMD,1 the doses of fludarabinc and mitoxantronc were reduced on subsequent cycleEbook Practical chemotherapy - A multidisciplinary guide: Part 2
s if an earlier cycle resulted in any of the following: platelet count <20 X 109/L; granulocyte count <0.1 X 109/L: mucosal bleeding: sepsis; blood coFMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2ted that in this study patients who were considered to be particularly at risk of haematological toxicity (poor prior tolerance of chemotherapy, prior extensive radiotherapy, age >65 years) were started on treatment with mitoxantrone and fludarabine doses 20% lower than those described above. Such p Ebook Practical chemotherapy - A multidisciplinary guide: Part 2atients should be treated with particular caution.•Renal function should be assessed at the start of treatment. Unless the patient is known to have reEbook Practical chemotherapy - A multidisciplinary guide: Part 2
nal problems which are likely to impair renal function significantly, estimation of the CrCl from the serum creatinine levels using the Cockcroft-GaulFMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, predn Ebook Practical chemotherapy - A multidisciplinary guide: Part 2in)FMD (fludarabine, mitoxantrone, dexamethasone), also known as FND (fludarabine, Novantrone K, dexamethasone) and FMP (fludarabine, mitoxantrone, prednGọi ngay
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