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Carmustine infusion reactions are more common with rapid administration

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Abstract

Purpose

Carmustine is a nitrosurea alkylating agent predominantly used at Peter MacCallum Cancer Centre as part of the autologous stem cell transplant induction regimens Stanford BCNU and BEAM. Acute infusion reactions were anecdotally reported to be higher than the reported rates of 10%, and it was suggested that the rate of infusion being employed was excessive. Some references suggest maximum infusion rates of 3 mg/m2/min for carmustine, a rate which is exceeded in the 2-h infusions used for Stanford BCNU, but not with BEAM.

Methods

A retrospective audit was conducted in 64 patients (57 Stanford BCNU, 7 BEAM) who had received these regimens between January 2009 and November 2010.

Results

Rates of infusion reaction to carmustine were higher than literature values, with reactions in Stanford BCNU (94.7%) being significantly higher than for BEAM (28.6%; P = 0.0003). These findings have resulted in a change of administration of carmustine in Stanford BCNU from 2 to 3 h. Further studies plan to compare the incidence of infusion reactions before and after the change in administration rates.

Conclusion

Patients receiving rapid infusion of carmustine in the Stanford BCNU regimen for stem cell conditioning have a high rate of infusion reaction. A maximum rate of 3 mg/m2/min is recommended.

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Acknowledgements

Thanks go to Victoria Bricknell, RN, for the initial observation that led to this audit.

Conflicts of interests

The authors have no competing interests.

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Authors and Affiliations

  1. Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia

    Brett Janson, Arti Thakerar & James D. Mellor

  2. Monash University, Parkville, Melbourne, Australia

    Pia Van Koeverden, Sing Wang Kevin Yip & James D. Mellor

Authors
  1. Brett Janson
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  2. Pia Van Koeverden
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  3. Sing Wang Kevin Yip
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  4. Arti Thakerar
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  5. James D. Mellor
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Correspondence to Brett Janson.

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Janson, B., Van Koeverden, P., Yip, S.W.K. et al. Carmustine infusion reactions are more common with rapid administration. Support Care Cancer 20, 2531–2535 (2012). https://doi.org/10.1007/s00520-011-1377-4

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  • DOI: https://doi.org/10.1007/s00520-011-1377-4

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