-5 Begin pentoxifylline 1600 mg/day po divided qid. 
Continue until day +30. 
-5 Begin IV fluid hydration at 100-150 cc/hr. 
Supplemental potassium and magnesium may be added 
as necessary, and bicarbonate infusion and 
allopurinol may be given in the rare patient at 
high risk for tumor lysis syndrome. 
-4 Melphalan 140 mg/m 2 X 1 over 30 minutes IV (see 
appendix for detailed drug information) . Patients 
greater than 20% over their ideal body weight will 
have their dose adjusted to: Ideal weight + 
(actual weight - ideal weight/2) . 
-3 200 cGy total body irradiation X 2. Dose rate 12.5 
mu/minute. A minimum of six hours will elapse 
between doses. .(See appendix for further 
information) 
-2 200 cGy total body irradiation X 2 
-1 200 cGy total body irradiation X 2 
0 Autologous marrow and peripheral blood stem cell 
reinfusion: Premedicate patients with 
hydrocortisone 100 mg IVP and benadryl 25 mg IVP. 
Cells are infused intravenously at the bedside 
over 30-120 minutes without a filter after rapid 
thawing in a 37 degree water bath. Total volume 
expected to be 100-500 cc. Possible toxicities 
include volume overload, which can be treated by 
slowing the infusion and using diuretics, and 
transient dyspnea due to mast cell degranulation 
induced by DMSO, which can be treated with 
additional antihistamines and steroids. 
+1... Begin granulocyte-macrophage colony-stimulating 
factor (G-CSF) 12 ug/kg/day as intravenous bolus 
, infusion, continue, until absolute neutrophil count 
reaches 1000/mm 3 fop three consecutive days, or 
day 28. ' If the ANC falls to < 500/ul after G-CSF 
discontinuation, - restart at prior dose. See 
appendix for detailed drug information. 
5.6 Alternative High-Dose Chemotherapy Regimen for Patients 
Ineligible for TBI. due . to Prior Radiotherapy. (See 
section 4.8) 
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