3. 
b. 
c. 
TBI 
2. Patients with previous history of cardiac problems and/or history of 
high-dose daunomycin should be first evaluated with cardiac ejection 
fraction studies. 
All patients will receive two lumbar punctures with intrathecal (IT) instillation 
of 12 mg MTX during the preparative period (see below). 
MTX levels. If the 48 hour level falls in the toxic range, consultation with 
the attending staff physician should be obtained for readjustment of subsequent 
IT dosages. 
Following 1-3 days of rest after CY administration, all patients will receive TBI at 
200 rad per day for a total of 6 days from opposing “Co sources at a dose rate of 6-7 
rad per minute. 
Sample Schedule: 
Start allopurinol on admission 
Day -10 IT MTX 12 mg 
-9 CY 60 mg/kg 
-8 CY 60 mg/kg 
-7 Rest 
-6 Rest; IT MTX 12 mg 
-5 200 rad 
-4 200 rad 
-3 200 rad 
-2 200 rad 
-1 200 rad (stop allopurinol) 
0 200 rad + marrow infusion 
4. Marrow Infusion 
Marrow will be aspirated under spinal or general anesthesia, screened and infused IV 
within 24 hours of termination of TBI. 
5. CNS prophylaxis 
Patients will receive IT MTX as outlined below during the first 100 days 
posttransplant. 
Days 32-12 mg IT 
46-12 mg IT 
60-12 mg IT 
74-12 mg IT 
88-12 mg IT 
102-12 mg IT 
6. Drug, Irradiation and Marrow Administration, Toxicities and Complications 
a. CY Administration 
1 . Dosage. C Y is administered at a dosage of 60 mg/kg on each of 2 
successive days (use lean body weight for obese patients). 
2. Antinausea, antiemetics: Nausea and vomiting can be well controlled 
with guideline #1, protocol #400. 
Recombinant DNA Research, Volume 15 
[619] 
