Protocol Index	

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RSH IP/ OP PRO00036433 / SGN70-101 / TREATMENT 	

Types:      Research Oncology Treatment
Synonyms:  MYELOID MALIGNANCIES, SEA-CD70 , SGN70

Cycle 1	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
·        Can be completed -1 day
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Tumor Lysis Syndrome Monitoring
·        Subjects must be monitored for TLS according to the institutional standard.
·        Recommended monitoring measures include: assessment of electrolyte levels starting on Day 1 and continued as frequently as clinically indicated through Day 4.
·        TLS monitoring is required during Cycles 1 and 2 only.
·        It is recommended that subjects are monitored for signs and symptoms of fluid volume overload, such as peripheral edema, neck vein distension, weight gain, and pulmonary crackles, as well as signs and symptoms of fluid volume deficit, such as dry mucous membranes, poor skin turgor, weight loss, and thirst. 
·        The use of physical assessment, strict intake and output, daily weights, and lab work results to monitor renal function are recommended measures to monitor for TLS.
·        In the event of TLS, immediate treatment must be administered according to the institutional standard, including hydration, administration of xanthine oxidase inhibitors or recombinant uricase, supportive care for electrolyte disturbances, and hemodialysis or hemofiltration if required.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: Per unit protocol	Occurrences: --		  	MEASURE WEIGHT	Interval: Once	Occurrences: --		  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECG
·        12-lead ECG conducted in triplicate.·        
·       Please correct the timepoint to: 24 hrs (+/- 4 hrs) after end of infusion on C4D1, taken prior to 24 hr PK blood draw

·    

o   Cycle 1: prior to 4 hr PK blood draw (+/- 15 mins) 
o   Cycle 4: 2 hrs (+/- 15 mins) after end of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: Until discontinued	Occurrences: --	Comments:	PK and Biomarker Assessments:
·        Predose (within 24 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2
·        1 hr after start if infusion (+/- 15 mins) only if infusion is > 1 hour: PK
·        2 hrs after start if infusion (+/- 15 mins) only if infusion is > 2 hours: PK
·        30 mins after end of infusion (+/- 15 mins): PK
·        2 hrs after end of infusion (+/- 15 mins): PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	LDH	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Nursing Orders
  	NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Pregnancy Test-
-  Must have a negative serum or urine pregnancy test (minimum sensitivity 25 mIU/mL or equivalent units of beta human chorionic gonadotropin [ß-hCG]) result within 3 days prior to the Day 1 of each treatment cycle. 
Pregnancy Test Requirement:
A negative pregnancy result is required before the subject may receive study drug.
			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: Once	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: Once	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: Once	Occurrences: --			Electrolyte Replacement
  	TREATMENT CONDITIONS 16	Interval: Until discontinued	Occurrences: --	Comments:	o	Serum magnesium 1.4 - 1.9mEq/L, supplement as below and OK to then give Romidepsin (if QTc <480).  
o	Serum magnesium 1.7 - 1.9mEq/L, give 2 grams magnesium sulfate IV.
o	Serum magnesium 1.4 - 1.6mEq/L, give 4 grams magnesium sulfate IV.
o	Serum magnesium less than 1.4mEq/L, Call MD/NP.

o	Serum potassium 3.3 - 3.9mEq/L, supplement as below and then OK to give Istodax (if QTc <480). 
o	Serum potassium 3.6 - 3.9mEq/L, give 40mEq KCL PO.
o	Serum potassium 3.3 - 3.5mEq/L, give 40 mEq KCL IV and 40 mEq KCl PO.
o	Serum potassium less than 3.3mEq/L, Call MD/NP.

o	EKG must be done prior to each dose-Must document the QTc - perform AFTER electrolyte supplementation. 
o	QTc >480, call MD; otherwise OK to give Romidepsin.
		  	magnesium sulfate IV 2 g	Dose: 2 g	Route: intravenous	once PRN	Start: S				  	magnesium sulfate IV 4 g	Dose: 4 g	Route: intravenous	once PRN	Start: S				  	potassium chloride (K-DUR) CR tablet 40 mEq	Dose: 40 mEq	Route: oral	once PRN	Start: S				  	potassium chloride 20 mEq in 100 mL IVPB (FOR CENTRAL LINE ONLY)	Dose: 20 mEq	Route: intravenous	every 1 hour prn over 60 Minutes for 2 doses	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: Until discontinued	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 2	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECG
·        12-lead ECG conducted in triplicate.·        
·       Please correct the timepoint to: 24 hrs (+/- 4 hrs) after end of infusion on C4D1, taken prior to 24 hr PK blood draw

·    

o   Cycle 1: prior to 4 hr PK blood draw (+/- 15 mins) 
o   Cycle 4: 2 hrs (+/- 15 mins) after end of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: Until discontinued	Occurrences: --	Comments:	PK and Biomarker Assessments
·      24 hours (+/- 4 hrs) after end of infusion on D1: PK
			Electrolyte Replacement
  	TREATMENT CONDITIONS 16	Interval: Until discontinued	Occurrences: --	Comments:	o	Serum magnesium 1.4 - 1.9mEq/L, supplement as below and OK to then give Romidepsin (if QTc <480).  
o	Serum magnesium 1.7 - 1.9mEq/L, give 2 grams magnesium sulfate IV.
o	Serum magnesium 1.4 - 1.6mEq/L, give 4 grams magnesium sulfate IV.
o	Serum magnesium less than 1.4mEq/L, Call MD/NP.

o	Serum potassium 3.3 - 3.9mEq/L, supplement as below and then OK to give Istodax (if QTc <480). 
o	Serum potassium 3.6 - 3.9mEq/L, give 40mEq KCL PO.
o	Serum potassium 3.3 - 3.5mEq/L, give 40 mEq KCL IV and 40 mEq KCl PO.
o	Serum potassium less than 3.3mEq/L, Call MD/NP.

o	EKG must be done prior to each dose-Must document the QTc - perform AFTER electrolyte supplementation. 
o	QTc >480, call MD; otherwise OK to give Romidepsin.
		  	magnesium sulfate IV 2 g	Dose: 2 g	Route: intravenous	once PRN	Start: S				  	magnesium sulfate IV 4 g	Dose: 4 g	Route: intravenous	once PRN	Start: S				  	potassium chloride (K-DUR) CR tablet 40 mEq	Dose: 40 mEq	Route: oral	once PRN	Start: S				  	potassium chloride 20 mEq in 100 mL IVPB (FOR CENTRAL LINE ONLY)	Dose: 20 mEq	Route: intravenous	every 1 hour prn over 60 Minutes for 2 doses	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: Until discontinued	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 3	Perform every 1 day x1		Electrolyte Replacement
  	TREATMENT CONDITIONS 16	Interval: Until discontinued	Occurrences: --	Comments:	o	Serum magnesium 1.4 - 1.9mEq/L, supplement as below and OK to then give Romidepsin (if QTc <480).  
o	Serum magnesium 1.7 - 1.9mEq/L, give 2 grams magnesium sulfate IV.
o	Serum magnesium 1.4 - 1.6mEq/L, give 4 grams magnesium sulfate IV.
o	Serum magnesium less than 1.4mEq/L, Call MD/NP.

o	Serum potassium 3.3 - 3.9mEq/L, supplement as below and then OK to give Istodax (if QTc <480). 
o	Serum potassium 3.6 - 3.9mEq/L, give 40mEq KCL PO.
o	Serum potassium 3.3 - 3.5mEq/L, give 40 mEq KCL IV and 40 mEq KCl PO.
o	Serum potassium less than 3.3mEq/L, Call MD/NP.

o	EKG must be done prior to each dose-Must document the QTc - perform AFTER electrolyte supplementation. 
o	QTc >480, call MD; otherwise OK to give Romidepsin.
		  	magnesium sulfate IV 2 g	Dose: 2 g	Route: intravenous	once PRN	Start: S				  	magnesium sulfate IV 4 g	Dose: 4 g	Route: intravenous	once PRN	Start: S				  	potassium chloride (K-DUR) CR tablet 40 mEq	Dose: 40 mEq	Route: oral	once PRN	Start: S				  	potassium chloride 20 mEq in 100 mL IVPB (FOR CENTRAL LINE ONLY)	Dose: 20 mEq	Route: intravenous	every 1 hour prn over 60 Minutes for 2 doses	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: Until discontinued	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 4	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: Until discontinued	Occurrences: --	Comments:	PK and Biomarker Assessments.
·     72 hours (+/- 4 hrs) after end of infusion on D1: PK, Serum
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	LDH	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Electrolyte Replacement
  	TREATMENT CONDITIONS 16	Interval: Until discontinued	Occurrences: --	Comments:	o	Serum magnesium 1.4 - 1.9mEq/L, supplement as below and OK to then give Romidepsin (if QTc <480).  
o	Serum magnesium 1.7 - 1.9mEq/L, give 2 grams magnesium sulfate IV.
o	Serum magnesium 1.4 - 1.6mEq/L, give 4 grams magnesium sulfate IV.
o	Serum magnesium less than 1.4mEq/L, Call MD/NP.

o	Serum potassium 3.3 - 3.9mEq/L, supplement as below and then OK to give Istodax (if QTc <480). 
o	Serum potassium 3.6 - 3.9mEq/L, give 40mEq KCL PO.
o	Serum potassium 3.3 - 3.5mEq/L, give 40 mEq KCL IV and 40 mEq KCl PO.
o	Serum potassium less than 3.3mEq/L, Call MD/NP.

o	EKG must be done prior to each dose-Must document the QTc - perform AFTER electrolyte supplementation. 
o	QTc >480, call MD; otherwise OK to give Romidepsin.
		  	magnesium sulfate IV 2 g	Dose: 2 g	Route: intravenous	once PRN	Start: S				  	magnesium sulfate IV 4 g	Dose: 4 g	Route: intravenous	once PRN	Start: S				  	potassium chloride (K-DUR) CR tablet 40 mEq	Dose: 40 mEq	Route: oral	once PRN	Start: S				  	potassium chloride 20 mEq in 100 mL IVPB (FOR CENTRAL LINE ONLY)	Dose: 20 mEq	Route: intravenous	every 1 hour prn over 60 Minutes for 2 doses	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: Until discontinued	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 5	Perform every 1 day x1		Electrolyte Replacement
  	TREATMENT CONDITIONS 16	Interval: Until discontinued	Occurrences: --	Comments:	o	Serum magnesium 1.4 - 1.9mEq/L, supplement as below and OK to then give Romidepsin (if QTc <480).  
o	Serum magnesium 1.7 - 1.9mEq/L, give 2 grams magnesium sulfate IV.
o	Serum magnesium 1.4 - 1.6mEq/L, give 4 grams magnesium sulfate IV.
o	Serum magnesium less than 1.4mEq/L, Call MD/NP.

o	Serum potassium 3.3 - 3.9mEq/L, supplement as below and then OK to give Istodax (if QTc <480). 
o	Serum potassium 3.6 - 3.9mEq/L, give 40mEq KCL PO.
o	Serum potassium 3.3 - 3.5mEq/L, give 40 mEq KCL IV and 40 mEq KCl PO.
o	Serum potassium less than 3.3mEq/L, Call MD/NP.

o	EKG must be done prior to each dose-Must document the QTc - perform AFTER electrolyte supplementation. 
o	QTc >480, call MD; otherwise OK to give Romidepsin.
		  	magnesium sulfate IV 2 g	Dose: 2 g	Route: intravenous	once PRN	Start: S				  	magnesium sulfate IV 4 g	Dose: 4 g	Route: intravenous	once PRN	Start: S				  	potassium chloride (K-DUR) CR tablet 40 mEq	Dose: 40 mEq	Route: oral	once PRN	Start: S				  	potassium chloride 20 mEq in 100 mL IVPB (FOR CENTRAL LINE ONLY)	Dose: 20 mEq	Route: intravenous	every 1 hour prn over 60 Minutes for 2 doses	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: Until discontinued	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 6	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·       168 hours (+/- 24 hrs) after end of infusion on D1: PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: Once	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: Once	Occurrences: --		  	LDH	Interval: Once	Occurrences: --		  	URIC ACID LEVEL	Interval: Once	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Electrolyte Replacement
  	TREATMENT CONDITIONS 16	Interval: Until discontinued	Occurrences: --	Comments:	o	Serum magnesium 1.4 - 1.9mEq/L, supplement as below and OK to then give Romidepsin (if QTc <480).  
o	Serum magnesium 1.7 - 1.9mEq/L, give 2 grams magnesium sulfate IV.
o	Serum magnesium 1.4 - 1.6mEq/L, give 4 grams magnesium sulfate IV.
o	Serum magnesium less than 1.4mEq/L, Call MD/NP.

o	Serum potassium 3.3 - 3.9mEq/L, supplement as below and then OK to give Istodax (if QTc <480). 
o	Serum potassium 3.6 - 3.9mEq/L, give 40mEq KCL PO.
o	Serum potassium 3.3 - 3.5mEq/L, give 40 mEq KCL IV and 40 mEq KCl PO.
o	Serum potassium less than 3.3mEq/L, Call MD/NP.

o	EKG must be done prior to each dose-Must document the QTc - perform AFTER electrolyte supplementation. 
o	QTc >480, call MD; otherwise OK to give Romidepsin.
		  	magnesium sulfate IV 2 g	Dose: 2 g	Route: intravenous	once PRN	Start: S				  	magnesium sulfate IV 4 g	Dose: 4 g	Route: intravenous	once PRN	Start: S				  	potassium chloride (K-DUR) CR tablet 40 mEq	Dose: 40 mEq	Route: oral	once PRN	Start: S				  	potassium chloride 20 mEq in 100 mL IVPB (FOR CENTRAL LINE ONLY)	Dose: 20 mEq	Route: intravenous	every 1 hour prn over 60 Minutes for 2 doses	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: Until discontinued	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 7	Perform every 1 day x1		Electrolyte Replacement
  	TREATMENT CONDITIONS 16	Interval: Until discontinued	Occurrences: --	Comments:	o	Serum magnesium 1.4 - 1.9mEq/L, supplement as below and OK to then give Romidepsin (if QTc <480).  
o	Serum magnesium 1.7 - 1.9mEq/L, give 2 grams magnesium sulfate IV.
o	Serum magnesium 1.4 - 1.6mEq/L, give 4 grams magnesium sulfate IV.
o	Serum magnesium less than 1.4mEq/L, Call MD/NP.

o	Serum potassium 3.3 - 3.9mEq/L, supplement as below and then OK to give Istodax (if QTc <480). 
o	Serum potassium 3.6 - 3.9mEq/L, give 40mEq KCL PO.
o	Serum potassium 3.3 - 3.5mEq/L, give 40 mEq KCL IV and 40 mEq KCl PO.
o	Serum potassium less than 3.3mEq/L, Call MD/NP.

o	EKG must be done prior to each dose-Must document the QTc - perform AFTER electrolyte supplementation. 
o	QTc >480, call MD; otherwise OK to give Romidepsin.
		  	magnesium sulfate IV 2 g	Dose: 2 g	Route: intravenous	once PRN	Start: S				  	magnesium sulfate IV 4 g	Dose: 4 g	Route: intravenous	once PRN	Start: S				  	potassium chloride (K-DUR) CR tablet 40 mEq	Dose: 40 mEq	Route: oral	once PRN	Start: S				  	potassium chloride 20 mEq in 100 mL IVPB (FOR CENTRAL LINE ONLY)	Dose: 20 mEq	Route: intravenous	every 1 hour prn over 60 Minutes for 2 doses	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: Until discontinued	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: Until discontinued	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: Until discontinued	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN	Start: S				  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: Until discontinued	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Within 5 minutes - 15 minutes after completion of infusion - 30 minutes after completion of infusion - 60 minutes after completion of infusion - 120 minutes after completion of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECG
·        12-lead ECG conducted in triplicate.
·        Cycles 1 and 4 only. 
·        Predose: within 30 mins before predose PK draw
·        Postdose:within 30 mins prior to post-dose PK draw
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
·        Predose (within 4 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2 [drawn regardless of if they receive study drug] [Serum, Plasma2, PBMC1, PBMC2 collected during Cycle 1 only]
·        30 mins after end of infusion (+/- 15 mins): PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 22	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
				Day 28	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·        Bone marrow examination (aspirate only) 
·        If cytogenetics are abnormal at baseline, they are required post-treatment.
·        Required between D22-28 on Cycle 1, Cycle 2, and every 2 cycles thereafter until CR/Cri/CRh. Window may be up to D35 in the even of a delay in the start of the next cycle of treatment. 
·        Additional bone marrow examinations should be performed and submitted as clinically indicated to confirm cellular recovery.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments 
·        Day 22-28: Serum, Plasma2, PBMC1, PBMC2
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
					
Cycle 2	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
·        Can be completed -1 day
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Tumor Lysis Syndrome Monitoring
·        Subjects must be monitored for TLS according to the institutional standard.
·        Recommended monitoring measures include: assessment of electrolyte levels starting on Day 1 and continued as frequently as clinically indicated through Day 4.
·        TLS monitoring is required during Cycles 1 and 2 only.
·        It is recommended that subjects are monitored for signs and symptoms of fluid volume overload, such as peripheral edema, neck vein distension, weight gain, and pulmonary crackles, as well as signs and symptoms of fluid volume deficit, such as dry mucous membranes, poor skin turgor, weight loss, and thirst. 
·        The use of physical assessment, strict intake and output, daily weights, and lab work results to monitor renal function are recommended measures to monitor for TLS.
·        In the event of TLS, immediate treatment must be administered according to the institutional standard, including hydration, administration of xanthine oxidase inhibitors or recombinant uricase, supportive care for electrolyte disturbances, and hemodialysis or hemofiltration if required.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Timepoints (+/- 5 mins window):
- Predose
- 15 mins after start of infusion
- 30 mins after start of infusion
o  45 mins after start of infusion
-  60 mins after start of infusion
- 30 mins intervals during infusion and after any change in rate of infusion
-  Within 5 mins after completion of infusion
-  15 mins after completion of infusion
-  30 mins after completion of infusion
-  60 mins after completion of infusion
-  120 mins after completion of infusion
-  240 mins after completion of infusion (Part A only)
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Weight.
·        Can be taken -1 day
·        Doses must be adjusted for subjects who experience a >/= 10% change in weight from baseline.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments for Cycle 2
·        Predose (within 4 hours of start of infusion): PK, Serum, Plasma2, PBMC1, PBMC2 [drawn regardless of if they receive study drug] [Serum, Plasma2, PBMC1, PBMC2 do not need to be drawn if subject had samples done within 2 weeks associated with marrow assessment]
·        30 mins after end of infusion (+/- 15 mins): PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Nursing Orders
  	NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Pregnancy Test-
-  Must have a negative serum or urine pregnancy test (minimum sensitivity 25 mIU/mL or equivalent units of beta human chorionic gonadotropin [ß-hCG]) result within 3 days prior to the Day 1 of each treatment cycle. 
Pregnancy Test Requirement:
A negative pregnancy result is required before the subject may receive study drug.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 2	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
·      24 hours (+/- 4 hrs) after end of infusion on D1: PK
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 3	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 4	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·     72 hours (+/- 4 hrs) after end of infusion on D1: PK, Serum
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 5	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 8	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·       168 hours (+/- 24 hrs) after end of infusion on D1: PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 9	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Within 5 minutes - 15 minutes after completion of infusion - 30 minutes after completion of infusion - 60 minutes after completion of infusion - 120 minutes after completion of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
 
PK and Biomarker Assessments for Cycle 2: 
-Predose (within 4 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2 [drawn regardless of if they receive study drug] [Serum, Plasma2, PBMC1, PBMC2 do not need to be drawn if subject had samples done within 2 weeks associated with marrow assessment]
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 22	Perform every 1 day x1		Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
				Day 28	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·        Bone marrow examination (aspirate only) 
·        If cytogenetics are abnormal at baseline, they are required post-treatment.
·        Required between D22-28 on Cycle 1, Cycle 2, and every 2 cycles thereafter until CR/Cri/CRh. Window may be up to D35 in the even of a delay in the start of the next cycle of treatment. 
·        Additional bone marrow examinations should be performed and submitted as clinically indicated to confirm cellular recovery.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments 
·        Day 22-28: Serum, Plasma2, PBMC1, PBMC2
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
					
Cycle 3	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
·        Can be completed -1 day
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Timepoints (+/- 5 mins window):
- Predose
- 15 mins after start of infusion
- 30 mins after start of infusion
o  45 mins after start of infusion
-  60 mins after start of infusion
- 30 mins intervals during infusion and after any change in rate of infusion
-  Within 5 mins after completion of infusion
-  15 mins after completion of infusion
-  30 mins after completion of infusion
-  60 mins after completion of infusion
-  120 mins after completion of infusion
-  240 mins after completion of infusion (Part A only)
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Weight.
·        Can be taken -1 day
·        Doses must be adjusted for subjects who experience a >/= 10% change in weight from baseline.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments for Cycles 3, 5, 6 and every 2 cycles thereafter
·        Predose (within 4 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2 [drawn regardless of if they receive study drug] [Serum, Plasma2, PBMC1, PBMC2 do not need to be drawn if subject had samples done within 2 weeks associated with marrow assessment]
30 mins after end of infusion (+/- 15 mins): PK [not required if PK assessment is scheduled within 24 hours of infusion related reaction]
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Nursing Orders
  	NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Pregnancy Test-
-  Must have a negative serum or urine pregnancy test (minimum sensitivity 25 mIU/mL or equivalent units of beta human chorionic gonadotropin [ß-hCG]) result within 3 days prior to the Day 1 of each treatment cycle. 
Pregnancy Test Requirement:
A negative pregnancy result is required before the subject may receive study drug.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-If no IRR is experienced during Cycle 1 or Cycle 2: premedications may be omitted beginning with Cycle 3 Day 1 dose onwards.
-If IRRs occur despite premedications: 
Treat with supportive care based on symptoms. Consider higher dose of corticosteroid and/or longer acting steroid with subsequent cycles. Additional premedications (eg, H2 blockers or leukotriene inhibitors) may be considered.
			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 2	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
·      24 hours (+/- 4 hrs) after end of infusion on D1: PK
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 3	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 4	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·     72 hours (+/- 4 hrs) after end of infusion on D1: PK, Serum
			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 5	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 8	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·       168 hours (+/- 24 hrs) after end of infusion on D1: PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 9	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Within 5 minutes - 15 minutes after completion of infusion - 30 minutes after completion of infusion - 60 minutes after completion of infusion - 120 minutes after completion of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·        for Cycles 3, 5, 6 and every 2 cycles thereafter
-        Predose (within 4 hours of start of infusion): PK, ADA [drawn regardless of if they receive study drug]
-        30 mins after end of infusion (+/- 15 mins): PK [not required if PK assessment is scheduled within 24 hours of infusion related reaction]
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-If no IRR is experienced during Cycle 1 or Cycle 2: premedications may be omitted beginning with Cycle 3 Day 1 dose onwards.
-If IRRs occur despite premedications: 
Treat with supportive care based on symptoms. Consider higher dose of corticosteroid and/or longer acting steroid with subsequent cycles. Additional premedications (eg, H2 blockers or leukotriene inhibitors) may be considered.
			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 22	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Bone Marrow Examination
·        Marrow aspirate only
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
				Day 28	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·        Bone marrow examination (aspirate only) 
·        If cytogenetics are abnormal at baseline, they are required post-treatment.
·        Required between D22-28 on Cycle 1, Cycle 2, and every 2 cycles thereafter until CR/Cri/CRh. Window may be up to D35 in the even of a delay in the start of the next cycle of treatment. 
·        Additional bone marrow examinations should be performed and submitted as clinically indicated to confirm cellular recovery.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
					
Cycle 4	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
·        Can be completed -1 day
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Timepoints (+/- 5 mins window):
- Predose
- 15 mins after start of infusion
- 30 mins after start of infusion
o  45 mins after start of infusion
-  60 mins after start of infusion
- 30 mins intervals during infusion and after any change in rate of infusion
-  Within 5 mins after completion of infusion
-  15 mins after completion of infusion
-  30 mins after completion of infusion
-  60 mins after completion of infusion
-  120 mins after completion of infusion
-  240 mins after completion of infusion (Part A only)
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Weight.
·        Can be taken -1 day
·        Doses must be adjusted for subjects who experience a >/= 10% change in weight from baseline.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECG
·        12-lead ECG conducted in triplicate.·        
·       Please correct the timepoint to: 24 hrs (+/- 4 hrs) after end of infusion on C4D1, taken prior to 24 hr PK blood draw

·    

o   Cycle 1: prior to 4 hr PK blood draw (+/- 15 mins) 
o   Cycle 4: 2 hrs (+/- 15 mins) after end of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments:
·        Predose (within 24 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2
·        1 hr after start if infusion (+/- 15 mins) only if infusion is > 1 hour: PK
·        2 hrs after start if infusion (+/- 15 mins) only if infusion is > 2 hours: PK
·        30 mins after end of infusion (+/- 15 mins): PK
·        2 hrs after end of infusion (+/- 15 mins): PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Nursing Orders
  	NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Pregnancy Test-
-  Must have a negative serum or urine pregnancy test (minimum sensitivity 25 mIU/mL or equivalent units of beta human chorionic gonadotropin [ß-hCG]) result within 3 days prior to the Day 1 of each treatment cycle. 
Pregnancy Test Requirement:
A negative pregnancy result is required before the subject may receive study drug.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 2	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECG
·        12-lead ECG conducted in triplicate.·        
·       Please correct the timepoint to: 24 hrs (+/- 4 hrs) after end of infusion on C4D1, taken prior to 24 hr PK blood draw

·    

o   Cycle 1: prior to 4 hr PK blood draw (+/- 15 mins) 
o   Cycle 4: 2 hrs (+/- 15 mins) after end of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
·      24 hours (+/- 4 hrs) after end of infusion on D1: PK
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 3	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 4	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·     72 hours (+/- 4 hrs) after end of infusion on D1: PK, Serum
			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 5	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 8	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·       168 hours (+/- 24 hrs) after end of infusion on D1: PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 9	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Within 5 minutes - 15 minutes after completion of infusion - 30 minutes after completion of infusion - 60 minutes after completion of infusion - 120 minutes after completion of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECG
·        12-lead ECG conducted in triplicate.
·        Cycles 1 and 4 only. 
·        Predose: within 30 mins before predose PK draw
·        Postdose:within 30 mins prior to post-dose PK draw
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
·        Predose (within 4 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2 [drawn regardless of if they receive study drug] [Serum, Plasma2, PBMC1, PBMC2 collected during Cycle 1 only]
·        30 mins after end of infusion (+/- 15 mins): PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 22	Perform every 1 day x1		Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
				Day 28	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·        Bone marrow examination (aspirate only) 
·        If cytogenetics are abnormal at baseline, they are required post-treatment.
·        Required between D22-28 on Cycle 1, Cycle 2, and every 2 cycles thereafter until CR/Cri/CRh. Window may be up to D35 in the even of a delay in the start of the next cycle of treatment. 
·        Additional bone marrow examinations should be performed and submitted as clinically indicated to confirm cellular recovery.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
					
Cycle 5	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
·        Can be completed -1 day
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Timepoints (+/- 5 mins window):
- Predose
- 15 mins after start of infusion
- 30 mins after start of infusion
o  45 mins after start of infusion
-  60 mins after start of infusion
- 30 mins intervals during infusion and after any change in rate of infusion
-  Within 5 mins after completion of infusion
-  15 mins after completion of infusion
-  30 mins after completion of infusion
-  60 mins after completion of infusion
-  120 mins after completion of infusion
-  240 mins after completion of infusion (Part A only)
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Weight.
·        Can be taken -1 day
·        Doses must be adjusted for subjects who experience a >/= 10% change in weight from baseline.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments for Cycles 3, 5, 6 and every 2 cycles thereafter
·        Predose (within 4 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2 [drawn regardless of if they receive study drug] [Serum, Plasma2, PBMC1, PBMC2 do not need to be drawn if subject had samples done within 2 weeks associated with marrow assessment]
30 mins after end of infusion (+/- 15 mins): PK [not required if PK assessment is scheduled within 24 hours of infusion related reaction]
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Nursing Orders
  	NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Pregnancy Test-
-  Must have a negative serum or urine pregnancy test (minimum sensitivity 25 mIU/mL or equivalent units of beta human chorionic gonadotropin [ß-hCG]) result within 3 days prior to the Day 1 of each treatment cycle. 
Pregnancy Test Requirement:
A negative pregnancy result is required before the subject may receive study drug.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 2	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
·      24 hours (+/- 4 hrs) after end of infusion on D1: PK
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 3	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 4	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·     72 hours (+/- 4 hrs) after end of infusion on D1: PK, Serum
			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 5	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 8	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·       168 hours (+/- 24 hrs) after end of infusion on D1: PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 9	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Within 5 minutes - 15 minutes after completion of infusion - 30 minutes after completion of infusion - 60 minutes after completion of infusion - 120 minutes after completion of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·        for Cycles 3, 5, 6 and every 2 cycles thereafter
-        Predose (within 4 hours of start of infusion): PK, ADA [drawn regardless of if they receive study drug]
-        30 mins after end of infusion (+/- 15 mins): PK [not required if PK assessment is scheduled within 24 hours of infusion related reaction]
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 22	Perform every 1 day x1		Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
				Day 28	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·        Bone marrow examination (aspirate only) 
·        If cytogenetics are abnormal at baseline, they are required post-treatment.
·        Required between D22-28 on Cycle 1, Cycle 2, and every 2 cycles thereafter until CR/Cri/CRh. Window may be up to D35 in the even of a delay in the start of the next cycle of treatment. 
·        Additional bone marrow examinations should be performed and submitted as clinically indicated to confirm cellular recovery.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments 
·        Day 22-28: Serum, Plasma2, PBMC1, PBMC2
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
					
Cycle 6	Repeat 1 time	Cycle length: 28 days	Day 1	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
·        Can be completed -1 day
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Timepoints (+/- 5 mins window):
- Predose
- 15 mins after start of infusion
- 30 mins after start of infusion
o  45 mins after start of infusion
-  60 mins after start of infusion
- 30 mins intervals during infusion and after any change in rate of infusion
-  Within 5 mins after completion of infusion
-  15 mins after completion of infusion
-  30 mins after completion of infusion
-  60 mins after completion of infusion
-  120 mins after completion of infusion
-  240 mins after completion of infusion (Part A only)
			Nursing Orders
  	ONC NURSING COMMUNICATION 2	Interval: --	Occurrences: --	Comments:	Weight.
·        Can be taken -1 day
·        Doses must be adjusted for subjects who experience a >/= 10% change in weight from baseline.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments for Cycles 3, 5, 6 and every 2 cycles thereafter
·        Predose (within 4 hours of start of infusion): PK, ADA, Serum, Plasma2, PBMC1, PBMC2 [drawn regardless of if they receive study drug] [Serum, Plasma2, PBMC1, PBMC2 do not need to be drawn if subject had samples done within 2 weeks associated with marrow assessment]
30 mins after end of infusion (+/- 15 mins): PK [not required if PK assessment is scheduled within 24 hours of infusion related reaction]
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Nursing Orders
  	NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Pregnancy Test-
-  Must have a negative serum or urine pregnancy test (minimum sensitivity 25 mIU/mL or equivalent units of beta human chorionic gonadotropin [ß-hCG]) result within 3 days prior to the Day 1 of each treatment cycle. 
Pregnancy Test Requirement:
A negative pregnancy result is required before the subject may receive study drug.
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 2	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments
·      24 hours (+/- 4 hrs) after end of infusion on D1: PK
			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 3	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 4	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·     72 hours (+/- 4 hrs) after end of infusion on D1: PK, Serum
			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 5	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 8	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·       168 hours (+/- 24 hrs) after end of infusion on D1: PK
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 9	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	-on days that Azacitidine is given patients should receive Dexamethasone 12mg with Ondansetron 16mg IV (instead of Methylpednisolone).
			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	-Azacitidine is only given in Parts D, E, F;
-- Given daily on Days 1-7. 
-- Modify treatment schedule if a shorter schedule (5-day) or a break-up schedule (5 days on, 2 days off, 2 days on) is needed. Consult a clinical pharmacist for treatment plan revision if needed.
--On days that SEA-CD70 and azacitidine are both administered, azacitidine should be administered prior to SEA-CD70 SQ.
			Chemotherapy
☑	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	Please select only one route: either IV or SQ
		☑	azaCITIDine (VIDAZA) 75 mg/m2 in sodium chloride 0.9% 50 mL chemo IVPB	Dose: 75 mg/m2	Route: --	once over 15 Minutes for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	50 mL	Yes	Yes	LACTATED RINGERS INTRAVENOUS SOLUTION	QS Base	 	No	Yes			☑	azaCITIDine (VIDAZA) 75 mg/m2 in sterile water (PF) chemo injection	Dose: 75 mg/m2	Route: --	once for 1 dose			Offset: 30 Minutes	Instructions:	Administer within 1 hour of reconstitution.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	AZACITIDINE 100 MG SOLUTION FOR INJECTION	Medications	75 mg/m2	Main Ingredient	No	WATER FOR INJECTION, STERILE INJECTION SOLUTION	Base	 	Always	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 15	Perform every 1 day x1		Appointment Requests
  	INFUSION APPOINTMENT REQUEST	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --	Comments:	·        Blood pressure, heart rate, and temperature. 
·        Within 5 minutes - 15 minutes after completion of infusion - 30 minutes after completion of infusion - 60 minutes after completion of infusion - 120 minutes after completion of infusion
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments.
·        for Cycles 3, 5, 6 and every 2 cycles thereafter
-        Predose (within 4 hours of start of infusion): PK, ADA [drawn regardless of if they receive study drug]
-        30 mins after end of infusion (+/- 15 mins): PK [not required if PK assessment is scheduled within 24 hours of infusion related reaction]
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
			Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Nursing Orders
  	sodium chloride 0.9 % infusion 250 mL	Dose: 250 mL	Route: intravenous	once @ 30 mL/hr for 1 dose	Start: S			Instructions:	To keep vein open.			Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	2 times daily	Start: S			Instructions:	--Administer 45 to 90 minutes prior to SEA-CD70 infusion.
--Repeat 4-6 hours after initial dose.		  	diphenhydrAMINE (BENADRYL) tablet 25 mg	Dose: 25 mg	Route: oral	2 times daily	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.
-  Twice. 
Repeat 4-6 hours after initial dose.		  	methylPREDNISolone sodium succinate (Solu-MEDROL) injection 40 mg	Dose: 40 mg	Route: intravenous	once over 45 Minutes for 1 dose	Start: S			Instructions:	Administer 45 to 90 minutes prior to SEA-CD70 infusion.			Chemotherapy
  	ONC PROVIDER COMMUNICATION 55	Interval: --	Occurrences: --	Comments:	--Please see page 48-49 of protocol regarding infusion rate. 
--Please see page 49-50 of protocol regarding dose modifications.
		  	INV-SEA-CD70 (SGNS70-101/Pro00036433/Shah) in sodium chloride 0.9% 250 mL infusion	Dose: --	Route: intravenous	once for 1 dose	Start: S			Instructions:	Administer intravenously using 0.2 micron inline filter. Rate per EPIC build. Stable for 8 hours at room temperature. 
First infusion rate: 50 mg/hour; if well tolerated, incrementally increase (no more than 2 fold increase) every 30 minutes as tolerated until maximum rate of 800 mg/hour is reached. Subsequent infusion, rate may be increased more rapidly in shorter time intervals. 
Caution: New Drug-Limited by Federal (USA) Law to Investigational use.
	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	INV-SEA-CD70 225 MG INJECTION (SGNS70-101/PRO00036433/SHAH)	Medications	 	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	250 mL	Yes	Yes				Hematology & Oncology Hypersensitivity Reaction Standing Order
  	ONC NURSING COMMUNICATION 82	Interval: --	Occurrences: --	Comments:	Grade 1 - MILD Symptoms (cutaneous and subcutaneous symptoms only – itching, flushing, periorbital edema, rash, or runny nose)
1. Stop the infusion.
2. Place the patient on continuous monitoring.
3. Obtain vital signs.
4. Administer Normal Saline at 50 mL per hour using a new bag and new intravenous tubing.
5. If greater than or equal to 30 minutes since the last dose of Diphenhydramine, administer Diphenhydramine 25 mg intravenous once.
6. If less than 30 minutes since the last dose of Diphenhydramine, administer Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
7. Notify the treating physician.
8. If no improvement after 15 minutes, advance level of care to Grade 2 (Moderate) or Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 4	Interval: --	Occurrences: --	Comments:	Grade 2 – MODERATE Symptoms (cardiovascular, respiratory, or gastrointestinal symptoms – shortness of breath, wheezing, nausea, vomiting, dizziness, diaphoresis, throat or chest tightness, abdominal or back pain)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
6. Administer Normal Saline at 150 mL per hour using a new bag and new intravenous tubing.
7. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous), Fexofenadine 180 mg orally and Famotidine 20 mg intravenous once.
8. If no improvement after 15 minutes, advance level of care to Grade 3 (Severe).
9. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	ONC NURSING COMMUNICATION 83	Interval: --	Occurrences: --	Comments:	Grade 3 – SEVERE Symptoms (hypoxia, hypotension, or neurologic compromise – cyanosis or O2 saturation less than 92%, hypotension with systolic blood pressure less than 90 mmHg, confusion, collapse, loss of consciousness, or incontinence)
1. Stop the infusion.
2. Notify the CERT team and treating physician immediately.
3. Place the patient on continuous monitoring.
4. Obtain vital signs.
5. If heart rate is less than 50 or greater than 120, or blood pressure is less than 90/50 mmHg, place patient in reclined or flattened position.
6. Administer Oxygen at 2 L per minute via nasal cannula. Titrate to maintain O2 saturation of greater than or equal to 92%.
7. Administer Normal Saline at 1000 mL intravenous bolus using a new bag and new intravenous tubing.
8. Administer Hydrocortisone 100 mg intravenous (if patient has allergy to Hydrocortisone, please administer Dexamethasone 4 mg intravenous) and Famotidine 20 mg intravenous once.
9. Administer Epinephrine (1:1000) 0.3 mg subcutaneous.
10. Assess vital signs every 15 minutes until resolution of symptoms or otherwise ordered by covering physician.
		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	PRN	Start: S				  	fexofenadine (ALLEGRA) tablet 180 mg	Dose: 180 mg	Route: oral	PRN	Start: S				  	famotidine (PEPCID) injection 20 mg	Dose: 20 mg	Route: intravenous	PRN	Start: S				  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	PRN					  	dexAMETHasone (DECADRON) IV 4 mg	Dose: 4 mg	Route: intravenous	PRN					  	epINEPHrine (ADRENALIN) 1 mg/1 mL injection 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	PRN	Start: S					Outpatient Electrolyte Replacement Protocol
  	TREATMENT CONDITIONS 39	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Potassium level LESS than 3.5 mEq/L; 
3. Recent pre-infusion labs.   

Dosing is based on lab value.
o Serum potassium less than 3.0mEq/L, give 40mEq KCL IV or PO and contact MD/NP. 
o Serum potassium 3.0 to 3.2mEq/L, give 40mEq KCL IV or PO. 
o Serum potassium 3.3 to 3.4mEq/L, give 20mEq KCL IV or PO. 
o Serum potassium 3.5 mEq/L or greater, do not give potassium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
		  	TREATMENT CONDITIONS 40 	Interval: --	Occurrences: --	Comments:	The protocol applies only if the following is met. 
1. SCr LESS than 1.5; 
2. Magnesium level LESS than 1.6 mEq/L; 
3. Recent pre-infusion labs. 

Dosing is based on lab value. 
o Serum Magnesium less than 1.0 mg/dL, give 2 gram magnesium sulfate IV and contact MD/NP. 
o Serum Magnesium 1.0 to 1.2 mg/dL, give 2 gram magnesium sulfate IV. 
o Serum Magnesium 1.3 to 1.5 mg/dL, give 1 gram magnesium sulfate IV. 
o Serum Magnesium 1.6 mg/dL or greater, do not give magnesium replacement. 

If patient meets criteria, order THERAPY PLAN called "Outpatient Electrolyte Replacement". 
Sign electrolyte replacement order as Per protocol: cosign required.
			Discharge Nursing Orders
  	ONC NURSING COMMUNICATION 76	Interval: --	Occurrences: --	Comments:	Discontinue IV.
			Discharge Nursing Orders
☑	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN					☑	HEParin, porcine (PF) injection 500 Units	Dose: 500 Units	Route: intra-catheter	once PRN	Start: S			Instructions:	Concentration: 100 units/mL. Heparin flush for Implanted Vascular Access Device maintenance.			Discharge Nursing Orders
  	alteplase (CATHFLO) for NON Quinton and NON Hemodialysis Catheters 2 mg	Dose: 2 mg	Route: intra-catheter	once PRN	Start: S			Instructions:	HOLD and notify provider if Platelets LESS than 50.  Instill dose into occluded catheter. Do not force solution into
catheter. After a 30-minute dwell time, assess catheter function by attempting
to aspirate blood. If catheter is functional, aspirate 4 to 5 mL of blood in
patients greater than or equal to 10 kg to remove Cathflo Activase and
residual clots. Gently irrigate the catheter with NS. If catheter remains
nonfunctional, let Cathflo Activase dwell for another 90 minutes (total dwell
time: 120 minutes) and reassess function. If catheter function is not restored,
a second dose may be instilled				Day 22	Perform every 1 day x1		Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  Serum bilirubin =1.5×upper limit of normal (ULN) or =3×ULN for subjects with Gilbert's disease, or direct bilirubin =2×ULN if total bilirubin is abnormal. 
-   Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =3×ULN. 
-    Estimated glomerular filtration rate (GFR) >60 mL/min using the Modification of Diet in Renal Disease (MDRD) study equation as applicable
				Day 28	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·        Bone marrow examination (aspirate only) 
·        If cytogenetics are abnormal at baseline, they are required post-treatment.
·        Required between D22-28 on Cycle 1, Cycle 2, and every 2 cycles thereafter until CR/Cri/CRh. Window may be up to D35 in the even of a delay in the start of the next cycle of treatment. 
·        Additional bone marrow examinations should be performed and submitted as clinically indicated to confirm cellular recovery.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments 
·        Day 22-28: Serum, Plasma2, PBMC1, PBMC2
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Nursing Orders
  	TREATMENT CONDITIONS	Interval: --	Occurrences: --	Comments:	-  WBC count <20,000/µL;  use of hydroxyurea to control WBC is acceptable.
					
IHR Follow - up	Repeat 1 time	Cycle length: 1 day	Day 1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments. -- PK, ADA

-IHR visit occurs on same day as IRR or 24 hours after. IHR FU visit occurs 24-72 hours after the IHR visit.
					
EOT	Repeat 1 time	Cycle length: 1 day	Day 1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Physical Examination.

--  Should include assessments of the following: abdomen, extremities, head, heart, lungs, neck, and neurological. For adult subjects only, measurements of height obtained within the prior 12 months may be utilized.
--  Required on Cycles 1-4 and every 4 cycles thereafter. Can be completed -1 day.
			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECOG Performance Status
·        Can be completed -1 day
			Nursing Orders
  	VITAL SIGNS - T/P/R/BP	Interval: --	Occurrences: --			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	ECG
·       12-lead ECG conducted in triplicate. No waiting period between each ECG.
·        Perform prior to PK and biomarker samples.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Labs
  	COMPREHENSIVE METABOLIC PANEL	Interval: --	Occurrences: --			Labs
  	LDH	Interval: --	Occurrences: --		  	URIC ACID LEVEL	Interval: --	Occurrences: --			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Labs
  	URINALYSIS SCREEN AND MICROSCOPY, WITH REFLEX TO CULTURE	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·       Bone marrow examination (aspirate), only required if not conducted within 4 weeks prior to EOT.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments. --·        PK, ADA, Serum, Plasma2, PBMC1, PBMC2
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	EORTC-QLQ-C30
·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PROMIS Fatigue SF-13a.

·        To be completed before treatment dosing and all other assessments or labs. 
·        Parts E and F only.
					
At time of response visit	Repeat 1 time	Cycle length: 1 day	Day 1	Perform every 1 day x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	PK and Biomarker Assessments. --Serum, Plasma2, PBMC1, PBMC2
			Provider Communication
  	ONC PROVIDER COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Bone Marrow Examination
·        Marrow aspirate only
			Provider Communication
  	ONC PROVIDER COMMUNICATION 6	Interval: --	Occurrences: --	Comments:	Qualitative Interview (Parts D, E, F only).
--Qualitative interview to be scheduled at the time of response (complete remission [CR], complete remission with partial hematologic recovery [CRh], partial remission [PR], and/or hematologic improvement [HI]), for the first 10 subjects with MDS or AML who agree to participate. Interview needs to be conducted within the following course (28 days).
					
LTFU	Repeat 1 time	Cycle length: 7 days	Day 1	Perform every 7 days x1		Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Concomitant Medication and AEs
·        Collect Day 1 pre-dose and through end of treatment visit or 30 days after last dose of study treatment, whichever is later.
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	-   As required per local regulations. At a minimum, collect at 8 weeks (+/- 1 week). For Parts D, E, and F also collect at 24 weeks (+/- 1 week).
			Nursing Orders
  	ONC NURSING COMMUNICATION	Interval: --	Occurrences: --	Comments:	Survival Status
--For subjects who discontinue treatment due to confirmed progression or relapse, contact subject for survival status and collection of subsequent anticancer treatment information every 6 weeks (+/-1 week) after EOT until death or study closure. 

 
 [CCT1]Physicians need to be aware that G-CSF or myeloid growth administration is allowed per protocol 

.
			Labs
  	HCG QUALITATIVE, SERUM SCREEN	Interval: --	Occurrences: --		  	HCG QUANTITATIVE, SERUM	Interval: --	Occurrences: --		  	HCG QUALITATIVE, URINE SCREEN	Interval: --	Occurrences: --			Labs
  	CBC WITH PLATELET AND DIFFERENTIAL	Interval: --	Occurrences: --			Provider Communication
  	ONC PROVIDER COMMUNICATION	Interval: --	Occurrences: --	Comments:	Response Assessment
·        Bone marrow examination
·        If cytogenetics are abnormal at baseline, they are required.
·        If study treatment discontinued prior to disease relapse or progression, obtain every 12 weeks (+/- 1 week) through 24 months after EOT, and every 4 months thereafter until initiation of another anticancer treatment, progression, or disease recurrence. 

·        Additional bone marrow examinations should be performed and submitted as clinically indicated to confirm cellular recovery.