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: 
r 
CONTINUATION: page 7 n f id. page 
Peripheral Blood Stem Cell Harvest by pheresis may cause 
infection, low blood pressure, light-headedness, nausea, and 
tingling around your mouth, fingers, and toes. 
5) 5-Fluorouracil ( 5FU) Treatment 
5-f luorouracil or 5-FU is a chemotherapeutic drug which we 
hope will help your marrow recover more quickly after 
transplantation. The 5-FU is given to you intravenously as a 
quick injection each day for three days beginning 10 days 
before your marrow harvest. When your bone marrow is 
harvested after 5-FU, it may be "primed" to recover more 
quickly. A bone marrow exam may be done prior to starting 5- 
FU to determine if you have an adequate number of bone- 
marrow cells and to be certain the leukemia has not 
. progressed. 
5-FU: The side effects of 5-FU which occur occasionally 
include mild sore mouth and throat, diarrhea, low white cell 
count or platelet count, bone marrow damage, dizziness, 
excessive tearing in your eyes. In the unlikely event that 
your blood counts are too low, the harvest will be postponed 
until your blood counts recover. 
6) Bone Marrow Harvest will take place approximately ten days 
after the beginning of the 5FU treatment. 
I; 
If your leukemia has progressed or failed to respond 
adequately to chemotherapy as determined by your doctor, 
proceeding with the marrow harvest and transplant should not 
be done since your chances of benefiting from the treatment 
would be extremely low. 
I 
Your bone marrow will be sucked out ("aspirated") through 
hollow needles while you are under general anesthesia. The 
procedure will take 1 to 3 hours and consists of a thorough 
cleansing of the skin over the back of the hip area followed 
by the insertion of sterile needles into the hip bones. One 
to two quarts of bone marrow is withdrawn. The marrow will 
then be frozen for preservation until you undergo 
transplantation. - Red blood cells removed along with the 
marrow will be returned to you after the procedure. 
CONTINUATION SHEET for either: 
Recombinant DNA Research, Volume 16 
PATIENT IDENTIFICATION 
[186] 
CPO »> 1 -3J9 
