tumor returns after the BMT and contains this marker then we would know that your/^our 
child’s marrow was contaminated. Similarly, if the marker was present in all types of 
your/your child’s blood cells then we would know that the marrow transplant could supply 
all the needs of your^your child’s blood system. This would help us plan better ways of 
treating AML. If you^our child were to have another transplant for AML in the future then 
these changes might affect youyyour child. Otherwise, the information we obtain would not 
help you^our child directly but may lead to improved treatment for others. 
High-Dose Chemotherapy 
A drug called busulfan >^1 be given to you^our child by mouth four times a day for 4 days. 
The second drug, cyclophosphamide (also called Cytoxan), will be started on the day after 
the last dose of busulfan and will be continued for 4 days. It will be given by vein (IV). If 
leukemia cells are found in the spinal fluid before starting treatment you^our child will 
receive methotrexate in the spinal fluid every 3 days until the cells are killed. The maximum 
number of spinal taps will be 5. 
Bone Marrow Transplant Procedure 
After the chemotherapy you^our child will have one day of rest then will receive 
transfusions of the previously frozen bone marrow through an IV catheter. The marrow will 
be obtained under general anesthesia from your^your child’s hip bones in the operating room 
as described above. Most of the marrow will be frozen immediately. If you agree, one third 
of the marrow will be treated with the marker gene, attached to a disabled virus to cany it 
into the cell. The marker will enter about 10% of the treated cells, so that 1 in 20-40 of the 
manow cells put back will be marked. This part of the manow will also be frozen and given 
back to youyyour child together with the untreated manow. To enable us to study the 
marked cells, a small amount of extra blood will be taken after the transplant. While 
youryyour child’s central line is in place this should not require extra needlesticks. The 
amount of extra blood to be taken will be about 20 ml (1 tablespoon) once or twice a week 
for 6 weeks, then monthly for 6 months and then every six months for two years and finally 
once a year for 2 years. Otherwise, the blood and manow tests and other investigations will 
be as necessary to give you/your child the most suitable clinical care. 
Bone manow aspirates and biopsies will be required on day 21 and 32 after the manow is 
given back. Bone manow aspiration will also be needed after you^our child have recovered, 
to see how well the graft is working. We will take these samples every 6 months for two 
years and then once a year for two years (total 6). 
After transplant no further treatment will be given unless youyour child had leukemic cells 
in the spinal fluid. If leukemic cells were present in the spinal fluid at any time in the past 
youyyour child will receive 5 spinal taps with methotrexate after transplant when normal 
blood production occurs. The maximum number of spinal taps any patient will receive is 10. 
Any marrow that you^our child will not need may be used for research. 
Recombinant DNA Research, Volume 14 
