VP-16 (see Appendix C) : 125 mg/m 2 in 1 liter of 
normal saline intravenously over 3 hours every 12 
hours for 6 doses on days 1 to 3 (total 750 mg/m 2 ) . 
The hydration given along with the VP16 and 
cyclophosphamide is 4 liters every 24 hours as 
tolerated. We will supplement this as necessary to 
maintain intravascular fluid volume and urine 
output. 
Total body irradiation (TBI) is 1020 centigrays. 
The patients are placed in the supine position and 
the TBI is directed from the right side with a 
calculated mid plane dose of 170 rads/ fraction, 
each fraction even bid starting day 6 to 8. 
b. Autologous peripheral blood and bone marrow will be 
reinfused on day 9 after the last dose of TBI after 
premedication with benadryl 25 mg and solucortef 
100 mg 30 minutes before reinfusion to prevent 
anaphylactic reactions. 
t 
c. Treatment of patients in the Protected Environment 
on the 12th floor of the Lutheran Pavilion is 
strongly urged. 
Patients will remain there until the attainment of 
500 granulocytes /mm 3 . 
d. Patients will receive bacterial (norf laxacin) and 
fursfol/yeast (fluconazole) antibiotic prophylaxis 
or other antibiotics specified by the Infectious 
Disease group while hospitalized to protect 
patients against overwhelming infection. 
e. All blood products will be irradiated from the 
start of treatment and for three months following 
transplantation . 
f. Back-up marrow will be given if the total ANC is 
still less than 500 at day 50. 
5.4 Maintenance Therapy: Alpha interferon maintenance 
therapy (see Appendix E) at a dose of l-9xl0 6 units three 
times a week will begin after a return of the platelet 
count to greater than 100,000/deciliter and an absolute 
granulocyte count greater than 2,000/deciliter occurs. 
This is used since it has been shown that 90% of the 
patients are interferon sensitive following transplant. 
The dose will be adjusted to keep WBC between 2 and 4 x 
10 3 /ul with a platelet count > 100 x 10 3 /ul. 
Recombinant DNA Research, Volume 15 
[867] 
