For patients with more than 1,000 mg/m^ of previous cumulative cisplatin. 
Carboplatin 600 mg/mVday IV, over one hour q.o.d. x 3 
VP-16 400 mg/m^/day IV, over 6 hours q.o.d. x 3 
11.3 Methods of Drug Delivery 
On the first day of chemotherapy, prehydration for 2 hours with 100 
ml/m^our of D5W 1/4 NSS, followed by carboplatin 700 or 600 mg/m^ in 100 
cc/m^ of dextrose 5% infused intravenously over 1 hour. VP-16 500 or 400 
mg/m^ in D5W 1/4 NSS will be administered over 6 hours: 1 hour loading dose 
followed by a 5 hour continuous infusion (24 hours after the start of 
carboplatin). This same sequence will be repeated q.o.d. x 3. 
Continuous intravenous hydration will be given throughout the course of 
chemotherapy (days -7 through 0) at a rate of 100 ml/m^/hr to maintain normal 
serum electrolytes. 
12.0 CONCURRENT TREATMENT AND SUPPORTIVE CARE 
During the high-dose chemotherapy, patients will receive standard supportive care (ie, 
emesis control, transfusions, antibiotics). 
12.1 Blood Products 
12.1.1 All blood products will be irradiated with 1500-3000 cGy until 
engraftment has been established as evidenced by absolute granulocyte 
counts of ^500/mm^. 
Allergic reactions, especially to platelet concentrates should be treated 
with Benadryl. Use of other antihistamines, corticosteroids, or pressors 
may be used as needed in refractory patients. 
The criteria for red blood cell use should be to maintain a hemoglobin 
concentration of 10 g/dl. 
Prophylactic platelet transfusion use. Irradiation platelet concentrates 
(4 units/m^) to prevent bleeding and to attempt to keep the circulating 
platelet count 20,000/mm^. As platelet use is expected to be frequent, 
family members who are potential apheresis donors should be sent to 
the blood bank for evaluation. Patients will be HLA treated and a 
12.1.2 
12.1.3 
12.1.4 
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