Busulfan (Busilvex ®, Myleran ®)
Busulfan (busilvex ®, myleran ®) is a chemotherapy drug given in high doses before a stem cell transplant. Stem cell transplants are used in the treatment of some types of leukaemia and other cancers. Busulfan is also given in lower doses to treat other blood-related disorders.
This information should ideally be read with our general information about chemotherapy and your type of cancer.
If you are having low dose busulfan, you will be able to take busulfan tablets as an outpatient. You'll see your doctor regularly while you have this treatment so they can monitor its effects.
If you are having high dose busulfan for a stem cell transplant, you will have it as an in-patient in the hospital ward. A chemotherapy nurse will give it to you.
During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
For high dose treatment your nurse will give you anti-sickness drugs before you start. They give you the drugs and chemotherapy through one of the following (depending if you have a line in or not):
a short thin tube (cannula) the nurse puts into a vein in your arm or hand
a fine tube that goes under the skin of your chest and into a vein close by (central line)
a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse gives you busulfan as a drip (infusion) into your cannula or line over two hours. They usually run the drip through a pump, which gives you the treatment over a set time.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
Busulfan may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include: a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having busulfan it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common, but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Taking your chemotherapy tablets
Before you leave hospital the nurse or pharmacist gives you chemotherapy tablets to take when you are at home. Always take your tablets exactly as explained. This is important to make sure they work as well as possible for you.
Swallow them whole with a glass of water. If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
When taking your tablets, remember to:
Keep them in the original package at room temperature away from heat and direct sunlight.
Keep them safe and out of the reach of children.
Return any remaining tablets to the pharmacist if your treatment is stopped.
Your course of busulfan
High-dose busulfan before a stem cell transplant is usually given four times a day,for four days, either as an infusion or as tablets. Or it can be given as a daily infusion for four days.
Lower dose busulfan can be given as a course of several sessions (or cycles) over a few months. The number of cycles depends on the type of cancer you have and your response to the treatment.
Your doctor or nurse will tell you more about this and the number of cycles you are likely to have.
Possible side effects of busulfan
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We explain the most common side effects of busulfan here. We don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
Risk of infection
Busulfan can reduce the number of white blood cells in your blood, especially in high dose treatment. This will make you more likely to get an infection. When the number of white blood cells is low, this is called neutropenia.
If you are at home, contact the hospital straight away on the contact number you’ve been given if:
your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
you suddenly feel unwell, even with a normal temperature
you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough or needing to pass urine often.
The number of white blood cells usually increases steadily and returns to normal before your next chemotherapy. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
If you are in hospital, your temperature will be checked regularly. Tell your doctor or nurse if you feel unwell in any way.
Bruising and bleeding
Busulfan can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
Busulfan can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started. Some anti-sickness drugs can make you constipated. Tell your doctor or nurse if this is a problem.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning, and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Chemotherapy may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. Busulfan can cause a rash, which may be itchy. Your skin may darken. It will return to its normal colour after you finish treatment. Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Hair loss is rare with standard doses of busulfan. If you are having high dose treatment with busulfan, all of the hair from your head will fall out. Your eyelashes, eyebrows and other body hair may also thin or fall out. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your scalp when you are out in the sun until your hair grows back. Your nurse can give you advice about coping with hair loss.
Having high-dose busulfan treatment may irritate your bladder and cause discomfort when you pass urine. Drink plenty of fluids - at least two litres (three and a half pints) during the 24 hours following chemotherapy. It is also important to empty your bladder regularly and to try to pass urine as soon as you feel the need to go.
You may be given fluids through a drip (infusion) to help prevent bladder irritation. Contact the hospital straight away on the number you’ve been given if you feel any discomfort or stinging when you pass urine, or if you notice any blood in it.
Your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Tummy pain and constipation
Busulfan may make you constipated and cause tummy pain. Drinking at least two litres of fluids (three and a half pints) every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take some regular gentle exercise.
Loss of appetite
You may lose your appetite during your treatment. Try to eat small meals regularly. Don’t worry if you don’t eat much for a day or two. If your appetite doesn’t improve after a few days, let your nurse or dietitian know. They can give you advice on getting more calories and protein in your diet. They may give you food supplements or meal replacement drinks to try. Your doctor can prescribe some of these and you can buy them from chemists.
You may get a bitter or metallic taste in your mouth or find that food tastes different. This should go away when your treatment finishes. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Changes in the way the kidneys and liver work
Busulfan can affect how your kidneys and liver work. This is usually mild and goes back to normal after treatment. You will have blood tests before chemotherapy to check how well your kidneys and liver are working.
Busulfan may make your eyes dry. Your doctor can prescribe eye drops to help with this. Very rarely, it may cause cataracts (clouding of the eye's lens) years later. Let your doctor know if you notice any changes in your vision.
Less common side effects of busulfan
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Effects on the nervous system
High doses of busulfan can affect the nervous system. You may feel drowsy or confused. Tell your doctor or nurse straight away if you notice any of these symptoms. It’s important not to drive or operate machinery if you notice these effects.
Rarely, this treatment can cause seizures (fits).You will be prescribed drugs to prevent this happening. Your doctor will explain more about this.
Changes to your heartbeat
Busulfan may cause changes to your heartbeat. This doesn’t usually cause serious problems and goes back to normal after treatment finishes. Let your doctor know if you notice your heartbeat is irregular, fast or slow. If you get pain in your chest or feel dizzy, go to your doctor straight away. You may have tests to check your heart before treatment.
Changes to the lungs
Busulfan can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, fever or feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Rarely, busulfan can increase the risk of developing a second cancer, years later. But the benefits of treatment usually far outweigh this risk. Your doctor can talk to you about this.
Other information about busulfan
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Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
You are advised to avoid paracetamol for 72 hours before taking busulfan and while you are having it.
Busulfan may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Changes to your periods
Chemotherapy can sometimes stop the ovaries working. You may not get a period every month and they may eventually stop. In some women, this is temporary but for others it is permanent and they start the menopause.
Your doctor will advise you not to become pregnant or father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Explain you are taking chemotherapy tablets that no one should stop or restart without advice from your cancer doctor. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This section has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed July 2013).
Perry MC. The Chemotherapy Source Book. 5th edition. 2012 Lippincott Williams and Wilkins.
With thanks to Catherine Loughran, Lead Haematology Pharmacist who reviewed this edition.
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