| Hematology: for both drugs (103/mL) |
|
| Neutrophils [≥1.5] and platelets [>100] |
100% |
| Neutrophils [1-1.49] or platelets [75-99] |
Delay, then dose at 50% after recovery |
| Neutrophils [<1] or platelets [<75] |
Delay, then dose at 50% after recovery |
| Creatinine clearance |
|
| For methotrexate only |
|
| >30 |
100% |
| 15-30 |
50% |
| <15 |
Omit |
| For cyclophosphamide only |
|
| ≥or |
100% |
| <10 |
Omit |
| Hepatic function tests: methotrexate only |
|
| ALT (2-3× ULN) and total bilirubin (2.98-4.97 mg/dL) |
2.5 mg daily on days 1 and 2 |
| ALT (>3× ULN) and total bilirubin (>4.97 mg/dL) |
Avoid use |
