6.1 Blood Products 
1. All blood products transfused beginning on day of 
cyclophosphamide infusion prior to peripheral blood 
stem cell harvest will be irradiated with 2000 cGy.and 
given through a leukocyte depletion filter. 
2. Platelets will be transfused in order to prevent 
bleeding and an attempt will be made to keep the 
circulating platelet count above 20,000/ul. Leukocyte- 
poor platelets and single donor apheresis platelets 
will be used to try and prevent alloimmunization. An 
attempt to find HLA-matched platelets will be made if 
the patient is refractory to standard single-donor 
apheresis platelets and has a positive HLA antibody 
screen. 
3. The hematocrit will be kept above 30% with 
leukocyte-poor, irradiated packed red blood cells. 
4. Febrile or mild allergic reactions to blood 
products will be treated with acetominophen, 
diphenhydramine, and if necessary, hydrocortisone and 
meperidine. 
6.2 Nutritional Support 
1. At the first sign of inadequate oral intake, total 
parenteral nutrition will be instituted. We expect 
that virtually all patients enrolled in this protocol 
will require TPN for 2-4 weeks. 
2. Patients receiving TPN will be followed by the 
Nutrition Support Service. 
6.3 Infectious Disease Management 
1. Once pre-transplant conditioning therapy with 
melphalan cind TBI begins, patients will be kept in a 
protected environment, in a single room, and will be 
asked to wear a mask when outside their room. Visitors 
and, staff will be required to follow strict handwashing 
practices. Children under the age of 12 will not under 
normal circumstances be permitted in the room. 
2. Patients will be placed on a low bacteria diet (no 
fresh fruits and vegetables) beginning on day -5 prior 
to transplantation. 
3. Once a patient has an absolute neutrophil count of 
less than 1000/ul, a fever of > 38.3 will require 
institution of broad spectrum antibiotics after full 
Recombinant DNA Research, Volume 16 
[53] 
