MEDICAL RECORD 
CONTINUATION SHEET for either: 
NIH 2514-1, Consent to Participate In A Clinical Research Study 
NIH 2514-2, Minor Patient's Assent to Participate In A Clinical Research Study 
1DY NUMBER: CONTINUATION: page j>__ of i!_ pages 
bone marrow has recovered from the cyclophasphami.de . You will 
then be given an intravenous infusion of a chemotherapeutic 
drug called 5-f luorouracil ( 5FU) daily for three days. We 
think the drug could "prime" the bone marrow to recover more 
quickly after transplantation. We will check the state” of 
your bone marrow 5 days after the first dose of 5-f luorouracil 
by doing a bone marrow aspiration and biopsy. 
The use of 5-f luorouracil in this situation is experimental. 
In a small number of patients given this drug before their 
bone marrow harvest, the recovery of platelets after the bone 
marrow transplant was faster. The side effects of 5-FU can 
include sore mouth and throat, diarrhea, low white cell count 
or platelet count, bone marrow damage, dizziness, and 
excessive tearing in the eyes. In the unlikely event that your 
blood counts are too low on the scheduled day of the bone 
marrow harvest, the harvest will be postponed until your blood 
~ counts recover. 
10 days after the first dose of 5-f luorouracil you will be 
brought to the operating room and put to sleep with general 
anesthesia. The skin on your back and buttocks will be 
carefully cleaned with antiseptics. Two or more small 
incisions will be made in the skin, and hollow metal needles 
will be inserted into *the back of your pelvic bones. Marrow 
cells will be sucked -out ("aspirated") through the needles. 
Over one hundred insertions of these needles into your pelvic 
bone may be necessary to collect enough cells, in a total 
volume of one or more quarts. You may require a blood 
transfusion in the operating room or after the procedure. Your 
bone marrow cells will be taken to the Blood Bank and frozen 
after processing to remove unecessary cells such as red blood 
cells. If possible, these extra red blood cells will be given 
back to you . 
The risks of the bone marrow harvest include complications of 
general anethesia, bleeding from the needle insertion sites, 
pain or tingling due to nerve damage in the buttocks, and 
infection at the needle insertion sites. These problems are 
very rare. You will probably experience an aching pain over 
your lower back for several days after the harvest. 
5 ) High-Dose Melphalan Chemotherapy and Total Body 
Irradiation: Before your stored bone marrow and peripheral 
PATIENT IDENTIFICATION 
CONTINUATION SHEET for either: 
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NIH-2514-t (10-84) 
Recombinant DNA Research, Volume 16 
