Busulfan

Also Known As: Myleran®

Class: Alkylating agent

Late Effect (1st of 3)

• ­Decreased functioning of the ovaries in females or testes in males (hypogonadism)
• Infertility
• Early menopause

Your risks are greater if:

• ­You are male.
• You are female and were treated during or after puberty.
• ­You had more than 600 mg/m².
• You received other alkylating agents.
• You had radiation therapy to the testicles, pelvis, or total body.

Recommended Evaluation

• History and physical exam, especially sexual history in males and menstrual history in females yearly
• Hormone levels (females - FSH, LH, estradiol; males - LH, FSH, testosterone) and semen analysis as indicated based on need

Management

• Because of the risk of early menopause, females should carefully weigh a decision to delay childbearing.
• ­You might need a referral to a reproductive endocrinologist for fertility concerns. Sometimes recovery of fertility occurs spontaneously many years after treatment.
• ­Your doctor may recommend a bone mineral density to see if you have osteopenia or osteoporosis.
• ­You may benefit from hormone replacement therapy; discuss it with your doctor.

Late Effect (2nd of 3)

Acute myeloid leukemia

Your risk is greater if:

• It has been less than 10 years since you finished treatment. (It is more common in first 10 years.)
• You received a higher cumulative dose or if you also received other alkylating agents, especially melphalan or mechlorethamine.

Recommended Evaluation

• ­Physical exam yearly
• Complete blood count and differential yearly for up to 15 years
• Evaluation of symptoms of fatigue, pallor, petechiae (small red rash), and bone pain
• ­Bone marrow evaluation if indicated

Management

• You will need to see a medical or pediatric oncologist for treatment if you develop AML.

Late Effect (3rd of 3)

Pulmonary fibrosis (loss of elasticity in the lungs leading to progressive difficulty breathing)

Your risk is greater if:

• ­You received a dose of 500 mg.
• ­You also received other therapy toxic to the lungs (e.g., bleomycin, cyclophosphamide, radiation to the chest or spine).
• ­You smoke cigarettes.

Recommended Evaluation

• Physical exam yearly
• ­Pulmonary function tests at the end of treatment, then every 2-3 years and as indicated

Management

• Do not smoke.
• Do aerobic exercise regularly to improve your stamina and endurance.
• ­You may need to have a consultation with a pulmonologist (doctor specializing in the breathing problems).
• ­Have flu vaccinations yearly.