Adult Dosing
Conditioning prior to allogeneic hematopoietic stem cell transplantation in CML (combination with cyclophosphamide)
- 0.8 mg/kg of ideal body weight or actual body weight (whichever is lower) IV q6 hrs for 4 consecutive days for a total of 16 doses
- Obese patients: Dosage shoud be based on adjusted ideal body weight (AIBW)
- Give phenytoin for seizure prophylaxis
Note- Should be administered via central line over 2 hrs
Pediatric Dosing
- Safety and effectiveness in pediatric population have not been established
- Busulfan at the recommended dose causes profound myelosuppression. Severe granulocytopenia, thrombocytopenia, anemia may occur
- Obtain CBCs with differential, platelet count, liver enzymes, bilirubin during treatment and until recovery
- May cause seizures; prophylactic therapy with phenytoin is recommended
- Hepatic veno-occlusive disease, interstitial pulmonary fibrosis, bronchopulmonary dysplasia, cardiac temponade and endocardial fibrosis have occured in patients receiving busulfan
- Ovarian suppression and amennorrhea with menopausal symptoms can occur during busulfan therapy in premenopausal women
- Monitor for infection and bleeding
- Overdosage has no antidote and it may lead to bone marrow depression and pancytopenia, therefore drug should be carefully administered
Cautions: Use cautiously in
- Hx of seizure disorder
- Concomitant use of potentially epileptogenic drugs
- Bone marrow depression (extreme caution required)
- Thalassemia (risk of cardiac temponade)
- Concomitant use of multiple alkylating agents (danger of hepatotoxicity)
- Head injury
Pregnancy Category:D
Breastfeeding: Most sources consider breastfeeding to be incompatible with breastfeeding. A single study of a woman receiving 4 mg qd (for 5 wks) for myeloid leukemia reported no adverse events on her nursing infant on weekly monitoring. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 10 September 2010). According to manufacturer's data, use during breastfeeding is contraindicated.
