b) Emesis after 30 minutes of the busulfan dose give only the 
number of tablets found in the emesis. 
9.2 cyclophosphamide (Q^oxan, CTX) NSC# 26271 
An alkylating agent related to the nitrogen mustards which is biochemically 
inert but metabolized by liver phosphamidases to active components which are 
excreted exclusively by the kidney. CTX in the study will be given at a dose 
of 50 mg/kg IV ideal body weight or actual body weight, whichever is lowest 
on each of four successive days. CTX is dissolved in 100-250 cc of D5W and 
administered over a 30-60 min period followed by IV hydration for 12 hr with 
2.4 L/ml 
9.2.1 Sedation and antinausea drugs: Nembutal 50 mg/m^ PO one hour prior 
to CTX and promazine (Sparine) 25 mg/m^ IV or PO two hours post 
CTX and pm every six hours. 
9.2.2 Diuresis and hydration: The urine flow during and for 12 hours after 
CTX administration is to be kept at a minimum of 2.5 cc/kg/hr. If the 
urine output decreases below these numbers, furosemide 10-20 mg/m^ 
IV may be given. IV fluids at 2.4 L/m^/12 hr post CTX will be 
routinely employed. A Foley catheter may be placed in young children 
if difficulty is measuring urine output occurs. 
9.2.3 Toxicity of cytoxan (CTX) 
a. Nausea and vomiting controlled with routine antiemetics. 
b. Fluid retention: CTX has an anti-diuretic effect usually 
counteracted by furosemide administration. Careful physical 
examination should be made and daily weights and electrolytes 
determined to detect fluid overload early. 
c. Cardiomyopathy: At doses greater than 2J00 mg/kg, CTX can 
cause fatal cardiac necrosis with heart failure. Patients are 
monitored by daily EKG’s to detect decrease in voltage. Non- 
specific ST changes are not unusual but a decrease in voltage is 
significant and ominous. CTX is contra-indicated in patients 
with existing cardiac disease. The EKG must be checked before 
each dose of cytoxan, patients developing significant reduction 
in cardiac voltage will have all subsequent doses discontinued. 
d. Diarrhea: Treated symptomatically. 
Recombinant DNA Research, Volume 14 
[521] 
