BMT UNIT

LEAM protocol over 6days

Height
Weight
BSA

Indications
Aggressive non-Hodgkin's lymphoma: chemosensitive
relapsed disease or poor prognostic disease.
Hodgkin's disease refractory to conventional therapy
or in second remission.
Indolent non-Hodgkin's disease refractory to second-line
therapy.
Eligibility criteria:
age <60years, ECOG 0-2, chemosensitive
lymphoma without active secondary spread to the
CNS (parenchymal brain, leptomeninges) with
complete or partial response, Bone marrow
infiltration 20% , adequate major organ function:
LVEF >50%, PFTs [FVC, FEV1, DLCO] > 60%
Sharma et al. SpringerPlus 2013, 2:489 and Experimental and Clinical
Transplantation (2012) 2: 163-167

predicted, creatinine < 1.7mg/dl, Bilirubin <2 x

ULN, no evidence of cirrhosis , ability to give
informed consent , no serious active infections
(HIV, TB, HBeAg, active bacterial/fungal disease)
Suggested Fluid Regimen
Start day-7or day -4 according to longer or
shorter protocol respectively ( --/--/20--)
500mls 0.9% NaCl + 20mmoles KCl +
1ampoule magnesium given over 3 hours
every 12hours alternating with dextrose 5%
500cc every 12hours ( ie total IV fluids /day 2
liters to be adjusted according to patients
need
DO NOT allow patient to get into significantly
positive fluid balance give Frusemide as
appropriate.

Conditioning:
Lomustine:
200mg/m2 PO day -6( --/--/20)
Cytarabine:
Cytarbine 200mg/m2 in 100cc 0.9% NaCl over 30minutes twice
daily day-5 to day-2 ( --/--,--/--,---/--and --/--/20 )
Etoposide:
200mg/m2 infusion in 500cc 0.9% NaCl over 2hours day-5 to
day -2( --/--,--/--,---/--and --/--/20 )

Sharma et al. SpringerPlus 2013, 2:489 and Experimental and Clinical

Transplantation (2012) 2: 163-167

Melphalan:
140mg/m2 infusion in 250cc 0.9% NaCl over 30minutes within
3hours of reconstitution day -1 ( --/--/20)

LEAM protocol over 3days

Conditioning:
Lomustine:
200mg/m2 PO day -3( --/--/20)
Cytarabine:
Cytarbine 1000mg/m2 in 500 cc 0.9% NaCl over 2hours daily
day -3 and day -2 ( --/--/20and --/--/20)
Etoposide:
1000mg/m2 infusion in 500cc 0.9% NaCl over 2hours day-3 and
day -2 ( --/--/20and --/--/20 )

Sharma et al. SpringerPlus 2013, 2:489 and Experimental and Clinical

Transplantation (2012) 2: 163-167

Melphalan:
140mg/m2 infusion in 250cc 0.9% NaCl over 30minutes within
3hours of reconstitution day -1 ( --/--/20)
PBSCs day 0 (

/20 )

Premedication 30minutes before PBSC

1. Give patient mint tablets
2. paracetamol 500mg 2 tablets PO
3. Ativan ( 1-2mg) amp IVpush
4. Dexamethasone 10mg IV push
5. Metoclopramide 10mg IV
6. NS 250cc IV Tubing at bedside on day of
transplant
7. Emergency medications including
epinephrine,hydrocortisone and benadryl will
be kept available at bedside
No other fluids or medications on day 0
PBSCsto be infused on day 0
:Other Measures
On day _______( day +1 ) start G- CSF____ mcg
(5ug/kg ) SC OD . If patient does not engraft by day
+21 , increase dose of G-CSF to 10ug/kg. Patients
who did not engraft before that , but are suffering
Sharma et al. SpringerPlus 2013, 2:489 and Experimental and Clinical
Transplantation (2012) 2: 163-167

from serious infection G-CSF dose can be increased

before that ( eg, by day +14)
Patients experiencing severe pain With G-CSF give
paracetamol 2tab /8hours and if not responding can
upgrade to tramadol . In severe pain patient can be
started on morphine infusion
Premedicate with granisteron 3mg IV+2amp
decadron +150cc D5w over 1 hour prior to
chemotherapy starting day -3 or day -6 for shorter or
longer protocol respectively ( --/--/200-) BID till last
dose of chemotherapy
Zyloric 300mg bd day (during chemotherapy ) then
300mg PO OD for 5 days
Epicogel 30cc PO /4hr ( PRN indigestion )
Imodium 1:2 cap for diarrhea up to 10 caps/
day .
Incentive spirometry / 2 hours while awake

Tantum mouth wash and mycostatin every 8 hours

Diflucan 150mg PO OD / day
On day ____ ( day 5 ) start cipro 500mg PO BD
On day ____ (day 5 ) start Flagyl 500mg BD PO
Ativan 1mg IVqhsprn ( at night )
For pain give __________ / 4 6 hours prn
Zovirax 250mg IV /8hours on shifting to oral when
patient can tolerate give zovirax400mg PO BID /day
BecozymeIV daily

Sharma et al. SpringerPlus 2013, 2:489 and Experimental and Clinical

Transplantation (2012) 2: 163-167

 SutrimDS bd twice / week but to be held when ANC

<1000 till engraftment then resume and to be
continued for 6 months after count recovery
Risek( omperazole) 20mg IV BD
Vital signs / 4hr , daily weight
Monitor PT & PTT weekly ,serum electrolytes,
Mg ,chemistry 3T weekly
CBC daily

Additional Requirements
If appropriate, discuss potential risk of infertility/early
menopause with patient and relatives. Consider sperm
banking for males and giving GnRH analogues for females
pre-transplant
.
All patients must receive irradiated cellular blood
components to prevent the rare occurrence of
transfusion associated graft versus host disease.
Check for microscopic haematuria using urine DipStix at
least 6 hourly. If it is positive increase IV fluids
frusemide to avoid volume overload.

Sharma et al. SpringerPlus 2013, 2:489 and Experimental and Clinical

Transplantation (2012) 2: 163-167