Adult Dosing
Brain tumors, multiple myelomas, Hodgkin's and non-Hodgkin's lymphomas
- Initial dose: 150 to 200 mg/m2 q6 wks, as a single dose or divided into 2 successive daily infusions
- Subsequent dosages should be adjusted according to hematologic response to the previous dose as follows
Table 1: Subsequent dose adjustments
| Leucocytes/mm3 | Platelets/mm3 | Percentage of prior dose to be given |
|---|
| > 4000 | > 100,000 | 100% |
| > 3000-3999 | > 75,000-99,999 | 100% |
| 2000- 2999 | 25,000-74,999 | 70% |
| < 2000 | < 25,000 | 50% |
Pediatric Dosing
Safety and effectiveness in pediatric patients have not been established
- Administer carmustine injection under supervision of qualified physician experienced in the use of cancer chemotherapeutic agents [US Black Box Warning]
- Carmustine injection may cause bleeding and overwhelming infections due to bone marrow suppression including thrombocytopenia and leukopenia [US Black Box Warning]
- Perform pulmonary function studies at baseline with frequent pulmonary function tests during treatment. Monitor for pulmonary toxicity in patients receiving greater than 1400 mg/m2 cumulative dose because they are at higher risk than those receiving less [US Black Box Warning]
- Monitor blood counts weekly for at least 6 weeks after a dose due to delayed bone marrow suppression. Do not give more frequently than every 6 weeks
- Appropriately adjust dosage on the basis of nadir blood counts from prior dose as the bone marrow toxicity of carmustine injection is cumulative
- Prior to initiating therapy evaluate risk vs benefit ratio of therapy. Suspend therapy if toxicity or adverse reactions occur
- Monitor liver function tests since therapy may cause liver dysfunction
- Renal abnormalities consisting of progressive azotemia, decrease in kidney size and renal failure have also been reported
Cautions: use cautiously in
- Pediatric population
- Myelosuppression
- Concurrent use of myelosuppressive agents
- Elderly population
- Long-term use
- Pregnancy
Pregnancy Category:D
Breastfeeding: Most sources consider breastfeeding to be contraindicated with antineoplastic therapy. In light of the potential for serious adverse events in nursing infants, it is recommended that patients receiving carmustine should not breastfeed.
