Revlimid

Must register patient in Revlimid REMS program; patient must understand toxicity with fetal exposure. Counsel patient on need for contraception; females: use 2 forms of contraception 4 weeks before, during therapy, during dose interruptions, and 4 weeks after therapy; males: use condom during and 4 weeks after therapy. Obtain 2 negative pregnancy tests (one within 10–14 days, and then another within 24hrs prior to starting therapy), repeat at least weekly for 1^st month then every 4 weeks (regular menstrual cycles) or every 2 weeks (irregular cycles); get informed consent. Patients must not donate blood during and for 4 weeks after therapy; males must not donate sperm for 4 weeks after therapy. Monitor for signs/symptoms of thromboembolic events; base thromboprophylaxis on patient's risks. Monitor for signs of infection, second primary malignancies, bleeding, or bruising. Obtain CBCs as follows: for MDS: weekly for first 8 weeks, then monthly thereafter; for MM: weekly for first 2 cycles, on Days 1 and 15 of Cycle 3, and every 28 days thereafter; for MCL: weekly for the first cycle, every 2 weeks during Cycles 2–4, and then monthly thereafter; for FL, MZL: weekly for first 3 weeks of Cycle 1, every 2 weeks during Cycle 2–4, and then monthly thereafter; all: dose interruption and/or reduction may be needed. May require blood product support and/or growth factors. Avoid in patients with a prior history of Grade 4 rash with thalidomide; consider interrupting or discontinuing for Grade 2–3 rash. Permanently discontinue if angioedema, anaphylaxis, Grade 4 rash, exfoliative or bullous rash, Stevens-Johnson syndrome, toxic epidermal necrolysis or DRESS occurs. Renal impairment (monitor). Monitor for tumor lysis syndrome in those with high tumor burden. Monitor liver enzymes (discontinue if elevation occurs), thyroid function before and during therapy. Lactose intolerance. Max 28-day supply per ℞. Nursing mothers: not recommended.

Must register patient in Revlimid REMS program; patient must understand toxicity with fetal exposure. Counsel patient on need for contraception; females: use 2 forms of contraception 4 weeks before, during therapy, during dose interruptions, and 4 weeks after therapy; males: use condom during and 4 weeks after therapy. Obtain 2 negative pregnancy tests (one within 10–14 days, and then another within 24hrs prior to starting therapy), repeat at least weekly for 1^st month then every 4 weeks (regular menstrual cycles) or every 2 weeks (irregular cycles); get informed consent. Patients must not donate blood during and for 4 weeks after therapy; males must not donate sperm for 4 weeks after therapy. Monitor for signs/symptoms of thromboembolic events; base thromboprophylaxis on patient's risks. Monitor for signs of infection, second primary malignancies, bleeding, or bruising. Obtain CBCs as follows: for MDS: weekly for first 8 weeks, then monthly thereafter; for MM: weekly for first 2 cycles, on Days 1 and 15 of Cycle 3, and every 28 days thereafter; for MCL: weekly for the first cycle, every 2 weeks during Cycles 2–4, and then monthly thereafter; for FL, MZL: weekly for first 3 weeks of Cycle 1, every 2 weeks during Cycle 2–4, and then monthly thereafter; all: dose interruption and/or reduction may be needed. May require blood product support and/or growth factors. Avoid in patients with a prior history of Grade 4 rash with thalidomide; consider interrupting or discontinuing for Grade 2–3 rash. Permanently discontinue if angioedema, anaphylaxis, Grade 4 rash, exfoliative or bullous rash, Stevens-Johnson syndrome, toxic epidermal necrolysis or DRESS occurs. Renal impairment (monitor). Monitor for tumor lysis syndrome in those with high tumor burden. Monitor liver enzymes (discontinue if elevation occurs), thyroid function before and during therapy. Lactose intolerance. Max 28-day supply per ℞. Nursing mothers: not recommended.