Busulfan

History

  • Discovered in 1961 -> pulmonary toxicity was reported soon after discovery

Indications

  • Myeloproliferative Disorders

Pharmacology

  • Alkylating Agent

Administration

  • IV: xxx

Adverse Effects

Pulmonary Adverse Effects

Pneumonitis (see Pneumonia, [[Pneumonia]] and Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])

  • Incidence: approximately 6% (range: 2.5-43%)
  • Risk Factors
    • Pulmonary toxicity may be related to concomitant chemotherapy or radiation therapy
    • Pulmonary toxicity is not related to cumulative dose or age
  • Diagnosis
    • CXR/Chest CT: combined alveolar infiltrates (due to desquamation of epithelial cells into alveoli) and interstitial infiltrates
      • Desquamation of alveolar cells may so extensive in some cases as to mimic pulmonary alveolar proteinosis
  • Clinical
    • Average Latency Between Busulfan Treatment and Onset of Pulmonary Symptoms: 3.5 years (range: 6 weeks-10 years)
      • Typically insidious onset
    • Cough
    • Dyspnea
    • Fever
  • Treatment
    • Discontinue Busulfan
    • Corticosteroids (see Corticosteroids, [[Corticosteroids]]): not clear that corticosteroids have any benefit though
    • Whole Lung Lavage: may be used for cases with extensive desquamation
      • Less effective than in idiopathic alveolar proteinosis
  • Prognosis: 80% mortality

Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS, [[Acute Lung Injury-ARDS]])

  • Epidemiology: xxx

Other Adverse Effects

  • Myleosuppression
  • Interaction with Metronidazole (see Metronidazole, [[Metronidazole]])

References

  • Busulfan and Metronidazole: An Often Forgotten but Significant Drug Interaction. Ann Pharmacother July/August 2011 vol. 45 no. 7/8: e39