Busulphan

Busulphan is an alkylating drug now used almost exclusively to treat chronic myeloid leukaemia; it is also used to treat polycythaemia rubra vera (1,2,3)

For chronic myeloid leukaemia it is given as either a daily dose or as pulsed dose every 4-6 weeks.

In polycythaemia rubra vera, an oral dose of 4-6mg daily effectively reduces the haematocrit in combination with venesection. It is a second-line drug due to the severity of its side-effects.

• study evidence has revealed no association between leukemic transformation and hydroxyurea or busulphan use if used in the treatment of polycythaemia (3)

Reference:

• Smith, A.G.. Polycythaemia & its management. Prescribers' Journal 1994;34:4:142-151.
• Haanen C, Mathe G, Hayat M. Treatment of polycythaemia vera by radiophosphorus or busulphan: A randomized clinical trial. Br J Cancer. 1981;44: 75 .
• Tefferi A et al. Survival and prognosis among 1545 patients with contemporary polycythemia vera: an international study.Leukemia. 2013 Sep;27(9):1874-81