Transcript Developing a condition regimen calculator as part of a successful

Roger Williams Medical Center a CharterCare Health Partner
Presenter: Mark Curtis RPh Clinical Informatics Pharmacist
 Discuss the current ASBMT Conditioning Regimen
Recommendations
 Recognize the importance of chemo dosing on
outcomes
 Demonstrate how a dosing calculator can support
doctors, pharmacists and nursing in safe patient
therapy
 Review the findings from a retrospective review of
patients from 2010 through 2014.
 Recognize the current ASBMT Conditioning
Regimen Recommendations
 Recognize the importance of appropriate
chemotherapy dosing
 Understand how accurate calculations are
needed before the preparation of chemotherapy
Presenter: Mark Curtis RPh Clinical Informatics
Pharmacist
Has no financial disclosures to report
Roger Williams Medical Center a CharterCare Health Partner
Drugs
Recommended Dosing
Busulfan
use AIBW25 for all mg/kg dosing
Carmustine
use BSA until TBW>120% then use AdjBSA25
Cyclophosphamide use TBW until TBW>120% of IBW then use AIBW25
Cytarabine
use BSA (based on TBW)
Etoposide mg/kg
use AIBW25 for all mg/kg dosing
Etoposide BSA
use BSA (based on TBW)
Fludarabine
use BSA (based on TBW)
Melphalan
use BSA (based on TBW)
rATG
Reference:
use TBW for mg/kg dosing
J.Bubalo et al. Biol Blood Marrow Transplant 20 (2014) 600-616
REGIMEN
Chemo Drugs
BEAM
Carmustine 300 mg/m2
Etoposide 100 mg/m2
daily
Cytarabine 100 mg/m2
Q12H
Melphalan 140 mg/m2
Day Day Day Day Day Day DAY
-6 -5 -4 -3 -2 -1 0
X
X
X
X
X
X
X
X
X
X
 Doctors, Nurses, Pharmacists all helped test the
calculator
 Regimen selection, patient metrics, and dose
calculations were all tested for accuracy
 Over 80 different patient examples were used for
testing
 Any discrepancy between the calculator and the
manual calculation were reviewed and reconciled
 109 patients transplanted at RWMC between 2010
and 2014
 Transplant types included Auto, Allo
(MRD/MUD) and Cord Blood
 Reviewed dosing variances between the current
ASBMT recommendations and the administered
dose
 Two groups: those with out a variance and those
who had a variance
Outcomes were reviewed:

Days to Engraftment of ANC and Platelets

Relapse rates

Survivor rates
It is very difficult to confirm cause and effect….
Dosing Variances (Table 1)
Conditioning
Transplant Type
N
Calc
Dose
Same
BEAM
Bu/Cy
Bu/Cy
Flu/Bu
Flu/Bu
Flu/Cy /TBI
Melphalan 140
Melphalan 200
AUTO
ALLO MUD
ALLO MRD
ALLO MUD
ALLO MRD
Cord Blood
AUTO
AUTO
23
8
2
18
7
6
26
19
8
2
0
3
0
4
10
8
15
6
2
15
7
2
16
11
Totals
109
35
74
Calc Dose
Variance
Dosing Variances by Drug (Table 2)
Conditioning
BEAM
BEAM
BEAM
BEAM
Bu/Cy
Bu/Cy
Flu/Bu
Flu/Bu
Flu/Cy/TBI
Flu/Cy/TBI
Melphalan
140
Melphalan
200
High Low
15
0
0
14
0
14
0
14
6
2
Wrong
AdjBSA
15
14
14
14
0
Wrong
AIBW
0
0
0
0
8
Drugs
Carmustine
Etoposide
Cytarabine
Melphalan
Busulfan
Cyclophosphamide
Fludarabine
Busulfan
Fludarabine
Cyclophosphamide
N
23
23
23
23
10
10
25
25
6
6
5
0
22
0
2
0
11
0
2
0
0
11
0
2
0
5
0
22
0
2
Melphalan
26
1*
15
15
0
Melphalan
19
0
11
11
Totals 219 50
83
96
*error in BSA calculation
0
37
 Some regimen specific differences in time to
engraftment between the two groups.
 Possible some differences in relapse and survivor
rates
 Numbers are not enough in each group to be
statistically significant
 The calculator supports consistent and accurate
regimen dosing that follows the latest ASBMT
recommendations.
 There may be some Possible clinical benefit to
strictly following the ASBMT recommendations
Todd Roberts MD Medical Director of BMT
RWMC
Kimberly Loftus Transplant Coordinator
RWMC
Alejandro Carvajal, MD RWMC
1. Which of the following statements is not true about
BMT Conditioning Regimens?
A. Dose adjustments are always done using the same
method, regardless of the drug being used.
B. When Adjusted Ideal Body Weight is used it is the
AIBW25.
C. BMT conditioning regimen calculations can be complex.
D. The intensity of therapy is important to patient outcomes
2. True or False: Using the calculator improves dosing
accuracy and may improve outcomes.
1. Which of the following statements is not true about
BMT Conditioning Regimens?
A. Dose adjustments are always done using the same
method, regardless of the drug being used.
B. When Adjusted Ideal Body Weight is used it is the
AIBW25.
C. BMT conditioning regimen calculations can be complex.
D. The intensity of therapy is important to patient outcomes
2. True or False: Using the calculator improves dosing
accuracy and may improve outcomes.