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
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
References