Protocols - Hemorio

Maintenance: Maintenance with thalidomide at the dosage of 50 to 100 mg/day must be started after the
first month of autologous transplantation if there is no a contra-indication (hypersensitivity, previous
peripheral neuropathy grade III or IV or child-bearing potential women). The maintenance with thalidomide
must be kept indefinitely.
The subjects with bone injuries must receive bisphosphonate monthly for at least 24 months. After 2
years, increase the interval to every 3 months for the subjects who need anti-myeloma therapy or
discontinue the usage in case of controlled disease.
Bortezomib: Desirable for the high-risk subjects who present a disease persistence or progression after
the autologous transplantation. Initial dose: 1.3 mg/m 2 D1, D4, D8 and D11 (cycles every 21 days).
Reduce the dosage according to the toxicity (neurological and hematological) or in cases of hepatic or
renal failure.
INFUSION PROTOCOL OF PERIPHERAL BLOOD STEM CELLS CRYOPRESERVED IN DMSO
- Physiological saline solution 500 mL IV before and after the infusion of CTSP;
- Mannitol 20% 100 mL IV and furosemide 10 mg before and after the infusion of CTSP;
- Promethazine 12.5 mg IV before the infusion of CTSP;
- Paracetamol 750 mg VO before the infusion of CTSP.
SUPPORT THERAPY
- transfusional support aiming the maintenance of Hb above 8g/dL and platelets above 10,000/µL. All
hemocomponents must be irradiated and filtrated;
- analgesic support for mucositis with morphine sulfate in a continuous infusion. Dilution of 0.1 mg/mL with
initial dosage recommended of 0.01 mg/kg/h;
- prevention and treatment protocol of oral mucositis with laser;
- initial treatment of the febrile neutropenia with cefepime 2g IV every 12 hours after the collection of
hemoculture of both paths of catheter and also of peripheral venous access. Vancomycin must be added
to the initial regimen in the cases of: homodynamic instability, infection in the central venous catheter site,
colonization by Staphylococcus sp MRSA and severe oral mucositis. The maintenance of vancomycin
must be guided by the results of the initial hemocultures. In cases of septic shock, one must change the
central venous access immediately and start the meropenem associate to vancomycin. The subjects that
present maintenance or recrudescence of fever with negative initial hemocultures must be followed and
recultured. In such cases, one must evaluate the change of cefepime by carbapenem and/or onset of
empiric antifungal therapy with amphotericin B. Subjects with a suspicion of invasive fusariosis or
aspergillosis must be treated with voriconazole;
- enteral and/or parenteral nutritional support must be evaluated at the subjects with a very reduced oral
ingestion, a bad pre-transplant nutritional status and with no perspective of improvement in a short time.
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