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Busulfan (Myleran, Busilvex)

Busulfan is a chemotherapy drug and is also known by its brand names Myleran or Busilvex. Busulfan tablets are called Myleran and the injections are called Busilvex.

You might have it as a treatment for:

  • chronic myeloid leukaemia (CML) 
  • other types of cancer that need treatment with a stem cell or bone marrow transplant
  • certain types of blood disorders called myelodysplastic syndromes (MDS)

How busulfan works

Busulfan is a type of chemotherapy drug called an alkylating agent. It works by sticking to one of the DNA strands of the cancer cell. The cell cannot then divide into 2 new cells. 

How you have busulfan

You have busulfan as tablets or you might have it as a drip into your bloodstream (intravenously).

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Into your bloodstream

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

When you have busulfan

You usually have busulfan as a course of several cycles of treatment.

For CML, you usually have busulfan at a low dose for as long as it is working. You have busulfan in higher doses if it is part of your preparation for a bone marrow or stem cell transplant. 

For MDS, you might have busulfan for as long as it is working and your blood tests are OK. Or you might have it over 6 weeks for example. This depends on your type of MDS and your situation.

Your doctor or pharmacist will explain how often and when you have busulfan. 

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include: 

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Fatigue

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

Sickness is more common with higher doses of busulfan (especially before a bone marrow or stem cell transplant). It is rare with low dose busulfan. 

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

This is common with high dose busulfan. But rare with low dose treatment.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Tummy (abdominal) pain

Tell your treatment team if you have this. They may give you medicine to help. 

Diarrhoea or constipation

Tell your doctor or nurse if you have diarrhoea or constipation. They can give you medicine to help. 

Indigestion

Contact your doctor or pharmacist if you have indigestion or heartburn. They can prescribe medicines to help.

Yellowing of the skin and whites of the eyes

This is called jaundice. It is caused by high levels of bile pigments in the blood. Let your doctor or nurse know straight away if you have this.

Difficulty sleeping, dizziness and depression

Difficulty sleeping, dizziness and depression can happen with high dose busulfan. Talk to your doctor if you have any of these.

Hair loss

You could lose all your hair if you have this drug into your vein (intravenous). This is less likely to happen if you have the busulfan tablets. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before. 

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • cough or breathing problems due to infection such as pneumonia
  • an increased the risk of developing a blood cancer such as acute leukaemia
  • blood in the urine

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • clouding of the eyes (cataract)
  • fits (seizures)
  • skin changes such as dryness, itching, rashes and reddening
  • high uric acid levels in your body due to the breakdown of tumour cells (tumour lysis syndrome) - you have regular blood tests to check for this and may take a tablet called allopurinol to treat this

Coping with side effects

We have more information about side effects and tips on how to cope with them.

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of fertility

You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

Don’t breastfeed during this treatment because the drug may come through into your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Last reviewed: 
03 Sep 2018
  • Electronic Medicines Compendium 
    Accessed January 2018

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination

    Public Health England

    First published: March 2013 and regularly updated on the Gov.UK website

  • Busulfan for myeloproliferative disorders, CML or relapsed/refractory AML

    South East London NHS Cancer Network, 2008

  • Busulfan, 6mg/ml, intravenous (Busilvex®)
    Scottish Medicines Consortium, 2006

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