acid and lactate dehydrogenase (LDH) has occurred at high (30 - 
60 mg/kg doses). A local reaction at the injection site may 
also occur. Splenomegaly with associated thrombocytopenia 
and thinning hair have been observed with prolonged 
administration in patients with chronic cyclic neutropenia. A 
few patients have had chest pain and edema after 
administration; hypotension during administration is rare. 
9.7 Bone marrow infusion will cause a garlic-like taste due to the 
DMSC (dimethyl sulfoxide) freezing agent. This may cause 
nausea and vomiting and the odor of the drug may persist for 4 
to 5 days following infusion. Patients may also develop 
shaking chills and fever within 4 hours of infusion which 
usually responds to demerol. Pulmonary symptoms with 
dyspnea are rare and usually only require supplemental oxygen. 
Hypotension is rare and will respond to fluids. Hemoglobinuria 
may rarely be seen due to infusion of lysed RBC's. 
10.0 Dose Modifications 
10.1 Vinblastine : Cycles will be delayed one week for an ANC 
<1500/jil or platelets <90,000/p.l. The Vinblastine dose will 
be escalated by 10% each cycle to achieve a nadir ANC 
<1000/p.l. The dose of vinblastine will be decreased by 25% 
for an ANC <500/p. for >5 days oi platelets <20,000/jil. 
10.1.1 If after a one week delay, the ANC is <1 500/p.l or 
platelets <90,000K, treatment with vinblastine can 
be given as below: 
If ANC is: 
1200-1499 
900-1199 
less than 900 
If platelet count is: 
75,000 - 89,000 
<75,000 
Vinblastine Dose : 
75% 
50% 
no drug 
Vinblastine Dose : 
50% 
no drug 
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Recombinant DNA Research, Volume 16 
