I 
I 
i 
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must be taken all at once and may be given through an NG tube. Please 
consult clinical nutrition (dietitian) for estimates of ideal body weight. 
9.1.1 Toxicity (BU) 
a) Hematologic - aplastic anemia. 
b) Addisonian-like syndrome with hyperpigmentation often 
unassociated with impaired corticosteroid production. 
c) Diffuse interstitial pneumonitis with fibrosis. 
d) Other toxic effects include erythematous skin rash, hepatic 
dysfunction, amenorrhea, testicular atrophy, gynecomastia, 
myasthenia symptoms and cataracts. 
e) Nausea and vomiting can occur after busulfan but is generally 
mild. 
f) Generalized seizures have been reported after use of high dose 
busulfan. All patients will be treated with dilantin 5 
mg/kg/dose (IV or PO) q 6 hr beginning on day -10 for 48 hr 
(8 doses), then 5 mg/kg daily until day -4. Patients developing 
seizures should be extensively evaluated and treated as clinically 
indicated. 
9.1.2 Some patients may vomit after administration of busulfan. Since 
gastric absorption is good and fairly complete within 30 to 45 minutes, 
the following guidelines should be used to replace doses after emesis. 
a) Emesis within 30 minutes of the busulfan dose repeat one-half 
of the dose after giving an andemetic. 
b) Emesis after 30 minutes of the busulfan dose give only the 
number of tablets found in the emesis. 
9.2 Cyclophosphamide (Cytoxan, CTX) NSC# 26271 
An alkylating agent related to the nitrogen mustards which is biochemically 
inert but metabolized by liver phosphamidases to active components which are 
excreted exclusively by the kidney. CTX in the study will be given at a dose 
of 50 mp/kg IV ideal body weight or actual body weight, whichever is lowest 
on each of four successive days . CTX is dissolved in 100-250 cc of D5W and 
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