Two patients without prior histories of neurologic disorders experienced generalized seizures while receiving high-dose busulfan (total dose 16 mg/kg) as part of a preparative regimen for allogeneic bone marrow transplantation. A review of the literature revealed 14 similar occurrences. Maintenance of therapeutic blood concentrations of Phenytoin in subsequent patients at our institution has resulted in no further patients experiencing generalized seizures. Prophylactic anticonvulsant therapy should be considered in patients receiving high doses of busulfan.
Get full access to this article
View all access options for this article.
References
1.
SantosGWTutschkaPJBrookmeyerR., Marrow transplantation for acute non-lymphocytic leukemia after treatment with busulfan and cyclophosphamide. N Engl J Med1983; 309: 1347–53.
2.
TutschkaPJCopelanEAKleinJP. Bone marrow transplantation for leukemia following a new busulfan and cyclophosphamide regimen. Blood1987; 70: 1382–8.
3.
HartmannOBenhamonEBeaujeanF., High dose busulfan and cyclophosphamide with autologous bone marrow transplantation support in advanced malignancies in children: A phase II study. J Clin Oncol1986; 4: 1804–10.
4.
BeelenDWQuabeckKGraevenV., Acute toxicity and first clinical results of intensive postinduction therapy using a modified busulfan and cyclophosphamide regimen with autologous bone marrow rescue in first remission of acute myeloid leukemia. Blood1989; 74: 1507–16.
5.
MartellRWSherCJacobsPMonteagudoF.High dose busulfan and myoclonic epilepsy (letter). Ann Intern Med1987; 106: 173.
6.
MarcusREGoldmanJM. Convulsions due to high dose busulphan (letter). Lancet1984; 2: 1463.
7.
VassalGDeroussentAHartmannOChallineD., Dose-dependent neurotoxicity of high dose busulfan in children: A clinical and pharmacologic study. Cancer Res1990; 50: 6203–7.
8.
HassanMEhrssonHSmedmyrB., Cerebrospinal fluid and plasma concentrations of busulfan during high dose therapy. Bone Marrow Transplant1989; 4: 113–4.
