Busulfan: High-Dose for SCT (Generic Name)

Other Names: Myleran®

About This Drug

Busulfan is used to treat cancer. It is frequently included in pre-transplant chemotherapy. In patients with leukemia and lymphoma, busulfan is used to destroy cancer cells and the existing bone marrow. This drug is given orally.

Possible Side Effects (More Common)

  • Nausea and vomiting. These symptoms may occur within one to six hours after you receive the drug and may last up to 48 to 72 hours.  
  • Bone marrow depression. This is a decrease in the number of white blood cells, red blood cells, and platelets. Bone marrow depression usually occurs five to seven days after the drug is given and may increase your risk of infection, fatigue, and bleeding. Transfusions of blood products may be required.
  • Decreased appetite
  • Diarrhea that may last for several days
  • Soreness of the mouth and throat. You may have red areas, white patches, or sores that are painful.
  • Darkening of the skin
  • Usually hair loss is temporary; your hair should grow back when treatment is completed. I
  • Increased total bilirubin in your blood. Your blood work will be monitored by your doctor.

Possible Side Effects (Less Common)

  • Seizures. Patients receiving the higher doses of busulfan that are used in bone marrow transplants (SCT) are at a slight risk for developing seizures. To help prevent seizures, you will be treated with an anti-seizure medication before, during, and after receiving busulfan.
  • Development of secondary leukemia (rare)
  • You could experience a decrease in the amount of steroids your body makes.
  • Irritation and bleeding in the bladder. This may cause blood in your urine. To prevent this, you will receive extra fluids to help you pass more urine.
  • Changes in lung tissue may occur with higher doses of busulfan. These changes may not be permanent, and your lung tissue may return to normal. Sometimes these changes may not be seen for many years. You may develop a cough or have difficulty catching your breath.
  • Changes in your liver function can occur causing yellowing of the skin or eyes or swelling in your abdomen.  Your doctor will monitor your liver function as needed.

Sexual Problems and Reproductive Concerns

In men and women both, this drug may temporarily or permanently affect your ability to have children. This cannot be determined before your therapy. In men, this drug may interfere with your ability to make sperm, but it should not change your ability to have sexual relations. In women, menstrual bleeding may become irregular or stop while you are receiving this drug. Do not assume that you cannot become pregnant if you do not have a menstrual period.  Speak with your doctor or nurse if you plan to have children.  Ask for information on sperm or egg banking.

 Genetic counseling is available to you to discuss the effects of this drug therapy on future pregnancies. In addition, a genetic counselor can review the potential risks of problems in the fetus due to this medication if an exposure during pregnancy has occurred. 

Pregnancy Warning: This drug may have harmful effects on the unborn child, so effective methods of birth control should be used during your cancer treatment. Talk with your doctor or nurse about effective methods of birth control.

Breast Feeding Warning: It is not known if this drug passes into breast milk.  For this reason, women are advised to discuss with their doctor the risks and benefits of breast feeding during treatment with this drug because this drug may enter the breast milk and seriously harm a breast feeding infant.

Women may experience signs of menopause like vaginal dryness or itching. Vaginal lubricants can be used to lessen vaginal dryness, itching, and pain during intercourse.

Treating Side Effects

  • Drink 6-8 cups of fluids every day unless your doctor has told you to restrict your fluid intake due to another medical condition. A cup is 8 ounces of fluid. If you vomit or have diarrhea, you should drink more fluids so that you do not become dehydrated.
  • Speak with your nurse about obtaining a wig before you lose your hair.  Also, call the American Cancer Society at 800-ACS-2345 to find out information about the “Look Good...Feel Better” program close to where you live. It is a free program where women undergoing chemotherapy learn about wigs, turbans and scarves as well as makeup techniques and  skin and nail care. 
  • Use sunscreen with SPF 30 or higher when you are outdoors even for a short time. Cover up when you are out in the sun. Wear wide-brimmed hats, long-sleeved shirts, and pants. Keep your neck, chest, and back covered.
  • Mouth care is very important. Your mouth care should consist of gently brushing with a very soft tooth brush and rinsing your mouth with a mixture of 1/2 teaspoon of salt in 8 ounces of water or 1/2 teaspoon of sodium bicarbonate (baking soda) in 8 ounces of water. This should be done at least after every meal and at bedtime.
  • Avoid mouthwash that contains alcohol. Avoid alcohol and smoking because they can irritate your mouth.
  • Do not floss.

Important Instructions

 It is important that you take all of the capsules. If you drop a capsule, or if you vomit any part of a dose, save the vomited fluids and call your nurse immediately. All or part of the dose may need to be repeated. You will be receiving medication to prevent nausea before each dose to prevent vomiting.

Food and Drug Interactions

There are no known interactions of busulfan with food. This drug may interact with other medication. Tell your doctor and pharmacist about all of the medication and dietary supplements (vitamins, minerals, herbs, and others) that you are currently taking. The safety and effectiveness of dietary supplements and alternative diets are often unknown. Using these might unexpectedly affect your cancer or interfere with your treatment. Until more is known, you should not use dietary supplements or alternative diets without your cancer doctor’s advice.

Other Instructions

Whenever you tell a doctor or nurse your health history, always tell them you have received high-dose busulfan.

When to Call the Doctor

Call your doctor or nurse immediately if you have any of the following symptoms:

  • Fever of 100.5 F (38 C) or above; chills
  • Unusual bleeding or bruising
  • Headache
  • Changes in vision
  • Seizures
  • Confusion
  • Cough or difficulty catching your breath
  • Swelling of legs, ankles, or feet
  • Abdominal or stomach pain
  • Yellowing of the skin or eyes
  • Bloody urine
  • Uncontrolled nausea that prevents you from eating and drinking
  • Vomiting more than twice in one day.

Call your doctor or nurse as soon as possible if you have any of the following symptoms:

  • Diarrhea of five or six stools in a day or diarrhea with weakness or lightheadedness
  • Painful mouth or throat that makes it difficult to eat or drink
  • Heavy menstrual bleeding that lasts longer than usual  

Revised November 2011

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