Baylor University Medical Center performs approximately 200 Blood and Marrow transplants annually in the inpatient and outpatient settings. The medication regimens prescribed for these patients at discharge are complex, confusing, and often prove overwhelming to patients during the transplant process. In our program, pharmacy staff works in conjunction with the physicians to provide medication education and teaching to transplant patients. We began using MedActionPlan.com, a free web-based tool that allows for the creation of personalized treatment plans for patients and saves their records in a program specific database. Each plan includes images of the medications prescribed, instructions of use, abbreviated drug information for each medication as well as a medication schedule checklist for patient use. This checklist may be used to record adherence, upcoming appointments or other relevant medical information. Plans may be customized to fit individual patient needs and have the option to be translated into Spanish. All medication plans are accessible from any computer by a user specific log-on and password. MedActionPlan.com is secure, and meets all HIPPA requirements and Joint Commission's goals for improving patient safety and education for medication therapy. The web-based program also contains an export function, allowing schedules to be sent directly to patients for their medication managment. These schedules can be customized into regular-print, large-font or wallet-sized versions depending on patient-specific needs. In addition to enhancing communication between the inpatient and outpatient facilities, MedActionPlan.com has empowered our patients and their caregivers to be proactive participants in their healthcare program. Patients are able to quickly refer to a centralized and comprehensive medication profile which allows for significantly improved understanding of, and ultimately, compliance with complex medication regimens. MedActionPlan.com has proved to be a valuable resource and has both enhanced the quality of patient education in our transplant program and improved the continuity of care between inpatient and outpatient settings. Baylor University Medical Center performs approximately 200 Blood and Marrow transplants annually in the inpatient and outpatient settings. The medication regimens prescribed for these patients at discharge are complex, confusing, and often prove overwhelming to patients during the transplant process. In our program, pharmacy staff works in conjunction with the physicians to provide medication education and teaching to transplant patients. We began using MedActionPlan.com, a free web-based tool that allows for the creation of personalized treatment plans for patients and saves their records in a program specific database. Each plan includes images of the medications prescribed, instructions of use, abbreviated drug information for each medication as well as a medication schedule checklist for patient use. This checklist may be used to record adherence, upcoming appointments or other relevant medical information. Plans may be customized to fit individual patient needs and have the option to be translated into Spanish. All medication plans are accessible from any computer by a user specific log-on and password. MedActionPlan.com is secure, and meets all HIPPA requirements and Joint Commission's goals for improving patient safety and education for medication therapy. The web-based program also contains an export function, allowing schedules to be sent directly to patients for their medication managment. These schedules can be customized into regular-print, large-font or wallet-sized versions depending on patient-specific needs. In addition to enhancing communication between the inpatient and outpatient facilities, MedActionPlan.com has empowered our patients and their caregivers to be proactive participants in their healthcare program. Patients are able to quickly refer to a centralized and comprehensive medication profile which allows for significantly improved understanding of, and ultimately, compliance with complex medication regimens. MedActionPlan.com has proved to be a valuable resource and has both enhanced the quality of patient education in our transplant program and improved the continuity of care between inpatient and outpatient settings.

Background: Nonablative transplant regimens are useful to treat patients who are elderly or too ill to undergo a full-intensity ablative allogeneic transplant regimen. However, this approach is limited by a higher relapse rate in some situations. We developed a novel conditioning regimen using the nucleoside analogue clofarabine (CLO) with busulfan (BU) to treat elderly patients with acute leukemia or high risk MDS who are not in remission or are at high risk of relapse.

Introduction: Low risk, curative therapy for patients with multiple myeloma remains elusive. Autologous stem cell transplant remains the standard of care for newly diagnosed multiple myeloma. Mobilization of adequate CD34+ cells can be a difficult task, especially in patients who have been heavily pretreated. We have compared the three mobilization regimens utilized at our facility and the subsequent CD34+ collections. Background: Standard chemotherapy is effective in maintaining control of multiple myeloma, however none has proven curative. Several trials have indicated that tandem or double autologous transplants may provide a significant benefit for overall survival and event free survival. When double transplants are planned, especially for patients who are heavily pretreated, collection of adequate CD34+ cells can prove to be challenging. Methods: 217 patients with multiple myeloma whose treatment plan included either a single or double autologous transplant were evaluated retrospectively. Data have been collected from January 1999 to March 2005. Mobilization regimens utilized were etoposide/cyclophosphamide+GCSF, 60 patients; cyclophosphamide+GCSF, 34 patients; and GCSF alone, 123 patients. Peripheral blood stem cells were collected following standard institutional procedures utilizing the Cobe Spectra apheresis machine. Standard CD34+ cell dose target for a single transplant was >2.0 × 106/kg. Results: Average and median CD34+ cell dose collected for patients receiving GCSF alone was 24.05 × 106/kg and 6.3 × 106/kg; cyclophosphamide+GCSF 13.28 × 106/kg and 9.75 × 106/kg; etoposide/cyclophosphamide+GCSF 39.98 × 106/kg and 30.4 × 106/kg. The average number of collections required for each regimen was 2.11 days for GCSF, 1.76 days for cyclophosphamide+GCSF, and 1.4 days for etoposide/cyclophosphamide+ GCSF. Conclusions: Etoposide/cyclophosphamide+GCSF mobilization regimen is highly effective in mobilizing large numbers of CD34+ cells in multiple myeloma patients making double or tandem transplants a viable treatment option. Introduction: Low risk, curative therapy for patients with multiple myeloma remains elusive. Autologous stem cell transplant remains the standard of care for newly diagnosed multiple myeloma. Mobilization of adequate CD34+ cells can be a difficult task, especially in patients who have been heavily pretreated. We have compared the three mobilization regimens utilized at our facility and the subsequent CD34+ collections. Background: Standard chemotherapy is effective in maintaining control of multiple myeloma, however none has proven curative. Several trials have indicated that tandem or double autologous transplants may provide a significant benefit for overall survival and event free survival. When double transplants are planned, especially for patients who are heavily pretreated, collection of adequate CD34+ cells can prove to be challenging. Methods: 217 patients with multiple myeloma whose treatment plan included either a single or double autologous transplant were evaluated retrospectively. Data have been collected from January 1999 to March 2005. Mobilization regimens utilized were etoposide/cyclophosphamide+GCSF, 60 patients; cyclophosphamide+GCSF, 34 patients; and GCSF alone, 123 patients. Peripheral blood stem cells were collected following standard institutional procedures utilizing the Cobe Spectra apheresis machine. Standard CD34+ cell dose target for a single transplant was >2.0 × 106/kg. Results: Average and median CD34+ cell dose collected for patients receiving GCSF alone was 24.05 × 106/kg and 6.3 × 106/kg; cyclophosphamide+GCSF 13.28 × 106/kg and 9.75 × 106/kg; etoposide/cyclophosphamide+GCSF 39.98 × 106/kg and 30.4 × 106/kg. The average number of collections required for each regimen was 2.11 days for GCSF, 1.76 days for cyclophosphamide+GCSF, and 1.4 days for etoposide/cyclophosphamide+ GCSF. Conclusions: Etoposide/cyclophosphamide+GCSF mobilization regimen is highly effective in mobilizing large numbers of CD34+ cells in multiple myeloma patients making double or tandem transplants a viable treatment option.

One year results from the development and utilization of a unified strategic business plan for marketing Blood and Marrow Transplant Services' Outpatient Clinic. The goal is to increase awareness of outpatient transplants and increase referrals. This is a follow-up from the 2003 Tandem BMT meetings. Blood and Marrow Transplant Services, PLLC is a subsidiary of Texas Oncology, P.A. The outpatient clinic recently doubled in size to 14,000 square feet in capacity with 6 private rooms, 16 infusion chairs and 15 exam rooms. Charged with the goal of increasing awareness of outpatient transplants and referrals, clinic administration developed a strategic plan through surveying physicians, patients and clinic personnel. After one year of this plan being in place, we now have results that show the strategic plan streamlined the referral process, increased awareness with Managed Care plans, and assisted with the streamlining of the Outpatient Transplant Clinic Operations. The main components of the plan include: BMT Outreach Programs to key physicians in regionBMT Transplant Managed Care Contracting initiativesCommunications Plan (Publications, Conferences, PR, Advertising, Internet)Clinic Operations Plan The plans include how we communicate internally and externally. This plan includes the development of our outreach program for referring physicians. The outreach program gives easy access to our BMT physicians for consultation and to gain answers to referring physician's questions. A goal of this program will show the cost-effectiveness of the outpatient program to the insurance/payer community. Our goal is to meet with all managed care and insurance companies to provide ongoing education on blood and marrow transplant services available on an outpatient basis.

The use of high dose oral busulfan has been a standard treatment regimen employed in the field of blood and marrow transplantation for over 30 years. The toxicity profile of high dose busulfan includes hematological, neurological and hepatic dysfunction. At doses of 16 mg/kg, the hematological toxicity requires stem cell rescue. Neurologic toxicity is mild, but has led to the routine use of phenytoin for seizure prophylaxis. The other principal toxicity of high dose busulfan is hepatic complications, primarily described as veno-occlusive disease (VOD). Historically, high dose busulfan has been administered orally over four days in a QID dosing schedule. The rationale for this dosing interval was primarily due to the large numbers of tablets patients had to swallow for a typical dose (i.e. a 70kg person would have to swallow 560 tablets). Additional concerns due to hepatic first-pass metabolism have been associated with inter-patient variation in plasma levels. The initial trials of a parenteral formulation of IV busulfan were designed to duplicate the oral dosing experience, and it was determined that 0.8 mg/kg every 6 hours X 16 doses was an equivalent dosing regimen. However, many transplant centers are exploring the feasibility of using once daily dosing (3.2 mg/kg daily times 4 days) versus the conventional dosing regimens. To date, we have enrolled 13 of 20 anticipated patients on an IRB approved protocol using once daily dosing of IV busulfan. These patients will be compared to historical controls who received intermittent dosing. Pharmacokinetic monitoring is being performed using the WINNONLIN® program. The primary objectives of the study are to compare hematopoietic engraftment, incidence and severity of VOD, interstitial pneumonitis, and seizure occurrence during drug administration. A preliminary analysis of the first 10 patients has not demonstrated any acute toxicities, and only one of the 10 patients has required a dosage adjustment.

Poster Presentations -Session II confirmation in a randomized trial is needed it appears that Ambi-some® 1 mg/kg/d is an efficacious and cost-effective approach to empiric antifungal therapy in patients with prolonged neutropenia and fever. 247