immediately following etoposide. MESNA will be administered first as a 
loading dose admixed with ifosfamide over 2 hours (hr 2-4, followed 
immediately by a 3 hour continuous infusion, hr 4-7). At completion of the 
infusion, MESNA is administered every 3 hours as an intravenous injection 
over 15 minutes x 6 doses (hr 7, 10, 13, 16, 19, 22) x 4 days. 
Etoposide will be mixed in 500 ml NS and infused over 90-120 minutes 
(maximum concentration of 1 mg/ml). Etoposide will be started prior to the 
ifosfamide on the first day of ICE and continued every 12 hours for 6 doses, 
ending on the third day of ICE. 
CBDCA will be administered as a continuous infusion over 72 hours starting 
on the first day of ICE. A 24-hour supply will be placed in 500 ml of D5W 
and infused through the lumen not being used for the ifosfamide/mesna. 
Management of fever and neutropenia should be done in collaboration with the 
Infectious Disease team and the principal investigator. Patients should not be 
discharged until afebrile and an absolute granulocyte count >500/mm 3 x 2 
consecutive days has been achieved. Patients may be discharged while 
receiving G-CSF. Patients may be discharged while still requiring platelet 
support provided there is no clinical bleeding and arrangements are made for 
outpatient platelet support. 
5.6 After ICE chemotherapy on days 1-4, patients will undergo bone marrow and PBSC 
reinfusion on Day 7. The bone marrow and PBSC to be reinfused will consist of the 
CD34+ stem cells that have been transduced with a retroviral vector bearing the MDR- 
1 gene as well as the 70% of the bone marrow harvest and PBSC that were 
cryopreserved without transduction. 
5.7 Beginning on Day 7 patients will be treated with G-CSF 10|ig/Kg SC daily until the 
ANC >2000/mm 3 on three successive days. 
5.8 Patients will be monitored with daily CBC, platelet count, differential, electrolytes, 
BUN, creatinine, calcium, phosphate, albumin, magnesium, and liver function tests. 
5.9 Patients with residual metastatic disease or progressive disease after bone marrow and 
PBSC transplant will be offered treatment with taxol chemotherapy provided their 
ANC > 1500/mm 3 and pits >90, 000/mm 3 . SGOT, SGPT and total bilirubin must be 
<2x normal unless there is evidence of tumor involvement in which case up to 4x 
normal SGOT and SGPT are allowed and a total bilirubin up to 1.8mg/dl. Patients' 
performance status must be ECOG 0, 1,2. Patients must have recovered from the 
toxicides of bone marrow transplantation. Taxol or vinblastine therapy may begin 
after the restaging studies have been obtained one month after their discharge from the 
hospital. Patients' disease sites will be imaged after every 2 cycles of taxol therapy. 
Patients will continue on taxol as long as their disease is stable or responding. Taxol 
will be administered by I.V. infusion at 175mg/M 2 for 3 hours by a central venous 
catheter. Dexamethasone, diphenhydramine and cimetidine premedications will be 
given in standard doses. Treatment with taxol will be repeated every 21 days. 
Patients previously treated for metastatic disease with taxol will be treated with 
vinblastine 1 .5mg/M 2 /day I.V. bolus for 5 days. The same eligibility criteria as for 
taxol administration will apply. G-CSF 5|ig/Kg will be given SC daily starting the 
next day and at least 24 hours after the end of taxol or vinblastine chemotherapy. G- 
CSF will be continued until the ANC >10, 000/mm 3 on two successive determinations. 
Vinblastine treatment will be repeated every 21 days. A minimum of 24 hours must 
elapse between the last dose of G-CSF and the next cycle of taxol or vinblastine. 
5.10 Doses of taxol and vinblastine on successive cycles will be escalated by 10% to 
achieve a nadir ANC count < 1000/mm 3 . Once this is achieved, the dose of the drug 
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