Mesna

Note: Mesna dosing schedule should be repeated each day ifosfamide is received. If ifosfamide dose is adjusted (decreased or increased), the mesna dose should also be modified to maintain the mesna-to-ifosfamide ratio. Prevention of ifosfamide-induced hemorrhagic cystitis: Standard-dose ifosfamide (manufacturer’s labeling): IV: Mesna dose is equal to 20% of the ifosfamide dose given for 3 doses: With the ifosfamide dose, hour 4, and at hour 8 after the ifosfamide dose (total daily mesna dose is 60% of the ifosfamide dose) Oral mesna (following IV mesna; for ifosfamide doses ≤2 g/m2/day): Mesna dose (IV) is equal to 20% of the ifosfamide dose at hour 0, followed by mesna dose (orally) equal to 40% of the ifosfamide dose given 2 and 6 hours after the ifosfamide dose (total daily mesna dose is 100% of the ifosfamide dose). Note: If the oral mesna dose is vomited within 2 hours of administration, repeat the dose or administer IV mesna. Short infusion standard-dose ifosfamide (2/day): ASCO guidelines: IV: Total mesna dose is equal to 60% of the ifosfamide dose, in 3 divided doses (each mesna dose as 20% of ifosfamide dose), given 15 minutes before the ifosfamide dose, and 4 and 8 hours after each dose of ifosfamide (Hensley, 2009) Continuous infusion standard-dose ifosfamide (2/day): ASCO guidelines: IV: Mesna dose (as a bolus) is equal to 20% of the ifosfamide dose, followed by a continuous infusion of mesna at 40% of the ifosfamide dose; continue mesna infusion for 12-24 hours after completion of ifosfamide infusion (Hensley, 2009) High-dose ifosfamide (>2.5 g/m2/day): ASCO guidelines: Evidence for use is inadequate; more frequent and prolonged mesna administration regimens may be required (Hensley, 2009) Other dosing strategies used in combination with ifosfamide (off-label dosing): Mesna continuous infusion: IV: 1.8 g/m2/day to 5 g/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, 2011) Mesna bolus followed by continuous infusion: 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) every 3 weeks for 6 courses (Juergens, 2006) Prevention of cyclophosphamide-induced hemorrhagic cystitis (off-label use): HDCAV/IE regimen for Ewing sarcoma: Children ≥4 years and Adults 2/day continuous infusion (mesna dose is equivalent to the cyclophosphamide dose) for 2 days with cyclophosphamide infusion during cycles 1, 2, 3, and 6 (Kolb, 2003) Hyper-CVAD regimen for ALL: Adults: IV: 600 mg/m2/day continuous infusion (mesna continuous infusion is same total dose as cyclophosphamide) on days 1, 2, and 3, beginning with cyclophosphamide and ending 6 hours after the last cyclophosphamide dose during odd-numbered cycles (cycles 1, 3, 5, 7) of an 8-cycle phase (Kantarjian, 2000)