LONG TERM FOLLOW-UP 
We will follow your progress over a long period. You will be examined here each year for 
four years after the treatment. For the next 10 years, your yearly exams can be done by 
your local doctor. At each exam, a teaspoon of blood will be taken. 
SIDE EFFECTS 
The drug treatment and transplant can produce bad side effects. These include permanent 
damage to the bone marrow, lung disease, liver disease, other cancers, severe vomiting, 
diarrhea, bleeding from the bladder, hair loss, serious infections, fevers, headaches, seizures. 
You may not ,be able to have children after this treatment. The special virus has not 
produced any bad side effects in anybody. It is possible that it might recover and grow, or 
stop some antibiotics from working or even cause cancer. We do not think this will happen, 
but it is possible. 
ALTERNATIVE PROCEDURES 
If you do not want to have your bone marrow marked you may have a bone marrow 
transplant without the marking. If you do not want your marrow "purged", you may have 
a bone marrow transplant without purging. You can also receive other drugs and radiation 
therapy or you could have no treatment at all. We believe that a transplant is most likely 
to cure you. 
STATEMENT OF UNDERSTANDING 
All information about your treatment will be kept among the hospital staff that need to 
know. We will not tell anybody else without asking you first. You have the right to ask any 
questions you want and they will be answered. You have had this assent form read or 
discussed with you by your parents and the doctor (Dr. ) caring for you. 
Before you signed this form you had all your questions answered. 
If you have any other questions you can ask your doctor or Drs. Robert Krance, Malcolm 
Brenner or Helen Heslop at any time. 
I agree to have my marrow marked. 
I do not agree to have my marrow marked. 
Patient 
Physician 
Date 
Parent or Guardian 
Witness 
Time 
[2721 
Recombinant DNA Research, Volume 17 
