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Accidental busulfan overdose during conditioning for stem cell transplantation
A Jenke1, J Freiberg-Richter, S Wilhelm
1Universitätsklinik Carl Gustav Carus, Medizinische Klinik I, Fetscherstrasse 74, 01307 Dresden, Germany. andreas.jenke@uniklinikum-dresden.de
Bone Marrow Transplantation
|November 30, 2004
Summary
Accidental high-dose busulfan (a chemotherapy drug) overdoses occurred in three patients undergoing bone marrow transplantation. Despite elevated drug levels, all patients survived, highlighting the potential for managing such events.
Area of Science:
- Hematology
- Pharmacology
- Oncology
Background:
- High-dose busulfan is a critical component of conditioning regimens for bone marrow transplantation.
- Accidental overdosing of busulfan can occur, necessitating an understanding of its toxicological profile and management.
Observation:
- Three cases of accidental busulfan overdosing are presented: two adults receiving 8 and 18 mg/kg, and a 14-year-old ingesting 36 mg/kg.
- Despite significantly elevated plasma busulfan concentrations, severe liver toxicity, including veno-occlusive disease, was not observed in any patient.
- One patient experienced seizures following busulfan ingestion.
Findings:
- Busulfan was eliminated via a first-order process in the observed cases.
- All patients survived the high-dose busulfan exposure, and successful bone marrow transplantation was achieved.
- Two patients later succumbed to refractory graft-versus-host disease (GvHD), while one remains alive in remission after 18 months.
Implications:
- These cases demonstrate that significant busulfan overdosing can occur without immediate fatal toxicity.
- Pharmacokinetic evaluation is crucial for assessing the risks associated with busulfan overdosing and predicting patient outcomes.
- Understanding busulfan pharmacokinetics can guide management strategies to mitigate early and late toxicities following transplantation.