3. Because of an incidence of hemorrhagic cystitis of 30%, fluid 
administration and management is recommended to prevent 
hemorrhagic cystitis per protocol #400, guideline #1. 
4. Toxicity and complications - Protocol #400, guideline #1. 
b. Fractionated TBI 
1. Dose 
See schedule above under section 6. A. 3. Dosimetry calculations are 
performed by the appropriate member of the support team. 
2. Fluid therapy during TBI - per protocol #400, guideline #2. 
3. Toxicity - Described in protocol #400 guideline #2. 
c. Marrow Infusion After TBI 
Marrow is infused IV without a filter as soon as it is aspirated and screened 
and no longer than 4 hours after aspiration. It may be infused anytime up to 
24 hours following TBI. 
1. Toxicity 
a. Volume overload. This can be avoided by centrifugation and 
removal of plasma, or by phlebotomy prior to infusion. This 
is of particular importance in small recipients who are 
receiving a large volume of marrow (>20 cc/kg). 
b. Pulmonary emboli. Usually not a problem but may occur due 
to fat and marrow emboli. Fatty marrows should be 
centrifuged to avoid this problem. The latter problem, when it 
occurs, is transient although temporary administration of 0 2 
may be necessary. 
c. Allergic reactions. Chills, fever, and hives occasionally occur 
presumably due to antigenic plasma components. These 
reactions are never severe and respond to parenteral benadryl. 
B. Posttransplant Immunosuppression (GVHD Prophylaxis) 
GVHD prophylaxis will be with cyclosporine alone. 
1 . Cyclosporine administration. All patients will receive CSP starting on the day 
before marrow infusion (day -1) in a dose of 3.0 mg/kg/day intravenously in 
two divided doses (1.5 mg/kg each) and infused over a period of 1-4 hours. 
Unless toxicities are encountered, CSP will be continued at the same dose 
until day 50. After day 50 the dose of CSP will be gradually reduced by 
5%/week and the drug discontinued at approximately 6 months after grafting. 
IV CSP will be discontinued once the patient starts eating and the drug will be 
given p.o. in a dose of 12.5 mg/kg/day in two divided doses (6.25 mg/kg 
each). To this purpose CSP will be provided in form of a drinking solution 
(milk, juice and chocolate). 
2. Toxicity. If vomiting occurs within 2 hours of administering PO CSP, an 
insufficient amount of the drug may have been absorbed and the dose should 
be repeated. Antinausea medication may be given as needed. 
If the patient is unable to keep CSP down, IV CSP may be administered at 
25% of the oral dose. Beside gastrointestinal toxicity, CSP may cause a rise 
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