I 
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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 
STUDY NUMBER: 
CONTINUATION: page JO. of 12_ pages 
this time the likelihood of these benefits is difficult to 
estimate given the low number of patients treated with this 
type of therapy , and the long duration of follow— up necessary 
to assess cure. 
ALTERNATIVES: Alternative approaches to this treatment plan 
exist for multiple myeloma, including no therapy or 
conventional treatments with lower doses of chemotherapy 
and/or radiation. With no therapy or conventional therapy, 
your tumor would be expected to progress at some time in the 
future. 
If your multiple myeloma relapses or does not respond 
completely to this therapy, you are free to try other 
treatment modalities that become available, either at this 
institution or at others. 
If you die before receiving your bone marrow and peripheral 
blood stem cells back, the cells will become the porperty of 
the National Institutes of Health and will be used for 
research purposes to try and learn more about multiple 
myeloma. Because you will have been part of a research study 
at NIH, if you die at any time during or after the study, your 
family or a designated power of attorney will be contacted 
about permission to dosa post-mortem examination. This consent 
form does not imply you or your family's consent to a post- 
mortem examination, but should serve as a stimulus for 
discussion of the issue between you, your family and your 
doctors . 
You are free to withdraw your consent to participate in this 
study at any time and to continue to receive care from the 
physician of your choice. However, withdrawal once you have 
received the high— dose chemotherapy and radiation but before 
receiving your bone marrow and peripheral blood stem cells 
back would be assoicated with a high risk of death. 
patient identification 
CONTINUATION SHEET for either: 
NIH-2S14-1 (10-64) 
Recombinant DNA Research, Volume 16 
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