Journal of Blood & Lymph

Busulfan Dosing Literature Review

Abstract

Gong CL, Rezvani AR, Kim T and Studdert AL

Introduction: There is debate regarding the use of busulfan every 6 hours (q6 h) compared to every 24 hours (q24 h) in patients undergoing hematopoietic cell transplantation.
Objectives: To review the literature to determine whether there is a significant difference between dosing busulfan q6 h vs. q24 h in adults, and to review dosing strategies to optimize daily dosing.
Methods: A literature search was conducted in PubMed with the terms “busulfan” and “transplant” and “24” in all fields. Results were further refined by using the terms “busulfan” and “transplant” and “pharmacokinetics”. Titles were then reviewed for relevance, and the remaining articles reviewed by abstract. Articles deemed relevant were then read in more thorough detail, and references cited by these articles reviewed to ensure a comprehensive review of the literature. Studies focusing on the pediatric population were not reviewed.
Results: 478 articles were identified, and of these, 372 contained the term “pharmacokinetics”. Based on abstract review, 26 relevant articles were identified. All articles confirmed that there are no differences in the pharmacokinetics of q6 h vs. q24 h dosing, and that safety appears equivalent between the two dosing schemes. One study noted an increase in the occurrence of acute graft-vs.-host disease (GVHD) and possibly increased gastrointestinal (GI) toxicity and stomatitis with q6 h dosing, while another noted a higher incidence of toxicity with q24 h dosing specifically in metastatic renal cell carcinoma patients. All articles concluded that both regimens are equally effective, but that q24 h dosing is more convenient and likely to decrease hospitalization, nursing, and pharmacy requirements.
Conclusions: There is no difference in efficacy or safety between busulfan q6 h and q24 h dosing. Institutions should consider moving to daily dosing of busulfan for improved convenience and decreased costs.