Carmustine (BCNU)

Indications

  • Glioma
  • Central Nervous System Tumors
  • Pre-Bone Marrow Transplantation (see Bone Marrow Transplant, [[Bone Marrow Transplant]])

Pharmacology

  • Bischloroethyl Nitrosourea (BCNU) = Carmustine

Administration

  • IV: xxx

Adverse Effects

Pulmonary Adverse Effects

Interstitial Pulmonary Fibrosis (see Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])

  • Epidemiology
    • Incidence of pulmonary toxicity: 1.5-20% of cases
    • Dose-Related Toxicity: 50% risk of lung toxicity at dose >1500 mg/m2 (however, toxicity may occur at lower doses)
    • Synergistic Factors Related to Toxicity
      • Cyclophosphamide (Cytoxan) (see Cyclophosphamide, [[Cyclophosphamide]])
      • Radiation Therapy
      • Possibly Other Chemotherapeutic Agents
  • Diagnosis: upper lobe-predominant interstitial infiltrates
  • Clinical
    • Delayed Onset of Fibrosis: onset of symptoms is usually delayed for >6 months (in some cases, symptoms may start years after exposure)
    • Fever (see Fever, [[Fever]]): less common than with other chemo agent toxicities
    • Absence of Clubbing
  • Treatment: withdraw drug + corticosteroids -> response is variable and may be transient
  • Prognosis: unpredictable outcome (may be fatal in some cases)

Upper Lobe Fibro-Bullous Changes (see Cystic-Cavitary Lung Lesions, [[Cystic-Cavitary Lung Lesions]])

  • Epidemiology: occurs many years after treatment -> in study with 17 year follow-up, 71% of cases developed upper lobe fibrosis
  • Clinical: intractably progressive course
  • Treatment: corticosteroids are ineffective

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

  • Epidemiology: case reports

Pneumothorax (see Pneumothorax, [[Pneumothorax]])

  • Physiology: may be related to upper lobe fibrobullous changes

Pulmonary Veno-Occlusive Disease (see Pulmonary Veno-Occlusive Disease, [[Pulmonary Veno-Occlusive Disease]])

  • Epidemiology: case reports

Other Adverse Effects

  • xxxx

References

  • xxx