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Author: Admin | 2025-04-28
Mesna infusion for 12 to 24 hours after completion of ifosfamide infusion (Hensley, 2009). Some centers have used a mesna dose equal to 60% to 100% of the ifosfamide dose as a continuous IV infusion beginning 15 to 30 minutes before the first ifosfamide dose and completed at least 8 hours after the end of the ifosfamide infusion (Moskowitz, 2001).Oral: ASCO guidelines: Total mesna dose equal to 100% of the ifosfamide dose, begin with IV dose equal to 20% for initial dose followed by oral dose at 40% of the ifosfamide dose at 2 and 6 hours after start of ifosfamide (Hensley, 2009); Note: Typically, oral doses of mesna are twice the IV dose.High-dose ifosfamide: Note: ASCO defines high dose as ifosfamide dosage ≥2500 mg/m2/day (Hensley, 2009); other pediatric oncology experts suggest ≥2000 mg/m2/day in protocols: Limited data available; dosing regimens variable: IV: ASCO considers evidence for use inadequate and dosing recommendations are not established; more frequent and prolonged mesna administration regimens may be required (Hensley, 2009). Some centers have used a mesna dose equal to 100% of the ifosfamide dose as a short IV infusions 5 divided doses (0, 3, 6, 9 and 12) hours after the start of ifosfamide) (Kliegman, 2007) or as a continuous IV infusion beginning 15 to 30 minutes before the first ifosfamide dose and completed at least 12 hours after the end of the ifosfamide infusion.Other dosing strategies have been used in combination with ifosfamide for specific regimens/protocols: Limited data available:Mesna continuous IV infusion: Children and Adolescents: IV: 1800 mg/m2/day to 5000 mg/m2/day as a continuous infusion (100% of the ifosfamide dose), repeated each day ifosfamide is received; see protocols for specific details (Bacci, 2003; Kolb, 2003; Moskowitz, 2001)Mesna IV bolus followed by continuous IV infusion: Children and Adolescents: IV: 1000 mg/m2 1 hour prior to ifosfamide on day 1, followed by 3000 mg/m2/day continuous infusion (continuous infusion is 100% of the ifosfamide dose) on days 1, 2, and 3 (with sufficient hydration); administer with subsequent ifosfamide doses (Juergens, 2006)Mesna (20% higher than ifosfamide) continuous IV infusion: Children and Adolescents: IV: 3600 mg/m2/day continuous infusion for 4 days (mesna dose is 20% higher than ifosfamide), with hydration, administer with subsequent ifosfamide doses (Le Deley, 2007)Prevention of cyclophosphamide-induced hemorrhagic cystitis: Limited data available: Note: Specific protocols should be consulted for combination regimens with cyclophosphamide. Mesna dosing schedule is typically repeated with each day cyclophosphamide is
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