5.5.2 
MESNA 
X X X X 
6400 mg/M 2 /day I.V. 
on days 1 to 4 (4 days) 
As outlined below: 
MESNA loading dose: 800 mg/M 2 I.V. with Ifosfamide (hr 2-4) 
Constant infusion: 800 mg/M 2 I.V. over 3 hr (hr 4-7) 
Bolus doses: 800 mg/M 2 /dose I.V. q 3 hr x 6 (hr 7, 10,..) 
Bone Marrow and PBSC Reinfusion Day 7 
Day 7: Begin G-CSF 10|!g/kg SC daily until ANC >2000/mm3 on 3 
successive days. 
ICE Administration: On admission and for 3 months following discharge, 
patients must take Bactrim DS 1 po BID Q Monday/Tuesday/Wednesday. All 
blood products, excluding transplanted cells, must be irradiated and a double 
luman Hickman catheter must be in place. MOUTH CARE: Peridex 
mouthwash 30 cc po swish and spit q 8 h; NaH 2 C 03 Rinse (2 tablespoon/500 
cc sterile H 2 O) 120 cc po swish and spit q4h; Clotrimazole Troche 10 mg suck 
q4h and if not tolerated, Nystatin 20 cc po swish and swallow q4h. ANTI- 
EMETIC REGIMEN (suggested): Ondansetron 0.15 mg/Kg IV q4 or q 6 
hours; Ativan 1-2 mg I.V. q8-12. Do not over-sedate patients and DO NOT 
GIVE STEROIDS. Droperidol and diphenhydramine are recommended for 
breakthrough nausea and vomitting. 
Hydration will start 24 hour prior to ICE and will be D5NS at 300 ml/hr on 
day 0 and repeat creatinine clearance will be obtained. Chemotherapy should 
start at 1 1:00 A.M. on day 1. Hydration will continue for at least 7 days after 
completion of ifosfamide if tolerated. Hydration will not be stopped without 
discussion with the principal investigator unless necessary for medical 
indications, e.g., CHF. Furosemide may be administered as needed to 
maintain urine output at >150 cc/hour and to reduce patient weight gain. 
Please note that many patients will initially gain 5% fluid body weight followed 
by a spontaneous diuresis. During ifosfamide administration (days 1-4), urine 
should be tested for hemoglobin daily and if gross hematuria develops, the 
principal investigator should be notified immediately and the next dose of 
ifosfamide held. If gross hematuria develops, a three-way Foley catheter is to 
be inserted and continuous bladder irrigation with 1 L/hr normal saline 
continued 24 hours beyond completion of chemotherapy (day 4). 
All patients will develop a metabolic acidosis (decreased serum CO 2 ) because 
of a transient proximal renal tubular acidosis (H 2 CO 3 loss) and accumulation 
of the ifosfamide by-product, chloracidaldehyde. The serum CO 2 level 
generally begins to fall by the third day of chemotherapy and reaches a nadir 3 
to 4 days later. When the serum CO 2 level falls to 18, the I.V. fluid changes to 
D5 1/2 NS + 50 meq/L Na H 2 CO 3 . If the CO 2 continues to fall to < 16, 12 
hours later, the I.V. fluid should be changed to D5 1/4 NS + 100 meq/L Na 
H 2 CO 3 . The Na 2 CC >3 should be removed with the CO 2 is stable and >22. 
For a serum potassium <3.5 mmol/L administer 15 mEq of potassium I.V. 
over 1 hour. Recheck serum potassium 1 hour after completing the potassium 
infusion. Alternatively potassium may be administered in hydration fluids. 
Patient's clinical associate should be called for a potassium <3.5mmol/L. 
Ifosfamide, admixed with 20% MESNA on a weight basis, will be 
administered in 100 ml D5W intravenously over 2 hours, daily x 4 days, 
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Recombinant DNA Research, Volume 18 
