BuFlu or Bu2Flu Therapy - BMT Conditioning
Busulfan (byoo-SUL-fan, Brand name: Myleran) + Fludarabine (flu-DARE-a-been, Brand name: Fludara)
How does it work?
Busulfan and fludarabine slow or stop the growth of cancer cells in your body. They help prepare your body for transplant. The treatment will also affect your normal cells. This may lead to harmful side effects.
How will I get this treatment?
Your doctor will decide how much chemotherapy you need to get ready for transplant. This process is called conditioning. You will get the treatment in a vein through an IV tube or a port that stays in place. (The port is called a TriFusion Catheter.) Here is your treatment schedule:
Day (-7) = ______________: Begin IV fluids
Day (-6) = ______________: Fludarabine IV over 1 hour followed by busulfan IV over 3 hours
Day (-5) = ______________: Fludarabine IV over 1 hour followed by busulfan IV over 3 hours
Day (-4) = ______________: Fludarabine IV over 1 hour
Day (-3) = ______________: Fludarabine IV over 1 hour and thymoglobulin IV over 6 hours
Day (-2) = ______________: Thymoglobulin IV over 4 hours and begin IV tacrolimus
Day (-1) = ______________: Thymoglobulin IV over 4 hours
Day (+0) = ______________: Transplant Day!
Methotrexate IV to be given on Days +1, +3, +6, and +11 after transplant.
What other medicines may I need during treatment?
- Ondansetron (brand name Zofran) to prevent nausea and vomiting
- Dexamethasone (brand name Decadron) to prevent nausea and vomiting
- Prochlorperazine (brand name Compazine) as needed for nausea and vomiting not controlled by other medicines
- Phenytoin (brand name Dilantin) to prevent seizures
- Ursodiol (brand name Actigall) to prevent liver problems
Before I get this treatment, what should I discuss with my doctor?
- Tell your doctor, nurse, and pharmacist the names of all your medicines. This includes over-the-counter medicines, vitamins, and herbal products.
- Tell your doctor, nurse, and pharmacist if you have any allergies.
- Talk to your doctor about drinking alcohol.
- Talk to your doctor before taking medicine with aspirin in it.
- Talk to your doctor before getting any vaccines, such as flu shots.
- Tell your doctor if you have any other health problems.
- Talk to your doctor if you are breastfeeding or plan to breastfeed.
What else should I know before treatment?
- These medicines may cause birth defects. Do not get pregnant while you or your sex partner get this treatment. You must use effective birth control during treatment. If you are pregnant or have questions about effective birth control methods, talk to your doctor before treatment.
- Do not breastfeed while you are receiving treatment.
- Remember to eat well, drink plenty of fluids, and stay active during cancer treatment.
What are some common side effects of this treatment?
Since this treatment affects your healthy cells, it may cause side effects. These are unwanted health problems caused by a treatment. If you have any side effects, let your transplant team know right away.
Here is a list of common side effects and ways you can prevent them.
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Too few white blood cells (neutropenia)
Low white blood cell count makes you more likely to get infections. You can take these steps to help prevent infection:
- Avoid close contact with people who have the flu or a cold. This includes children.
- Bathe every day. Wash your hands often.
- Keep your mouth clean.
- Keep all cuts and scrapes clean.
- Wear protective clothing when working in the yard.
- Do not cut your cuticles or ingrown nails.
- Do not wear fake nails.
- Do not handle pet litter boxes.
Call your doctor right away if you have any of the following:
- Temperature over 100.4°F (38°C) that lasts 1 hour or a spike in temperature to 101°F (38.3°C) or higher
- Other signs of infection: red, swollen, or painful sores; sore throat; painful urination; or chills
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Nausea and vomiting
You may have these around the time you get chemo treatment. These side effects will go away in time. You can prevent or manage these with medicine and diet changes.
- You may get anti-nausea medicines. These will control or reduce nausea and vomiting.
- Avoid fatty or spicy foods. Eating small meals more often instead of eating large meals.
- Drink 6-8 glasses of fluid every day.
Call your doctor if you have any of these:
- Feel weak or dizzy
- Lose consciousness
- See blood in your vomit
- Cannot drink more than 4 cups of fluid a day
Nausea and vomiting are unpleasant, but they are usually not dangerous. But you must tell you doctor if your nausea or vomiting is not controlled.
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Too few red blood cells (anemia)
Low red blood cell count may make you feel short of breath or more tired than usual. When you have less energy, you should:
- Get plenty of rest.
- Limit your activities.
Call your doctor right away if you feel extra tired when doing your normal activities.
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Too few platelets (thrombocytopenia)
When your platelets are low, you may bruise and bleed easier. To prevent bleeding, you should:
- Use an electric razor to avoid cuts.
- Use a soft toothbrush to clean your teeth.
- Check with your doctor before using over-the-counter pain medicine. This includes aspirin or ibuprofen.
- Avoid activities that might cause injury.
Call your doctor right away if you have any unusual bruising or bleeding.
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Diarrhea
If you have diarrhea, you must drink plenty of fluids and try to eat bland foods. These include rice, applesauce, bananas, toast, or cereal.
Call your doctor right away if you start having more bowel movements or if they become loose or watery. Your doctor may prescribe medicine to help decrease diarrhea.
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Skin and nail changes
This treatment may cause rash, itching, redness, or hives. It may also cause a change in skin color in patches. Busulfan may cause changes in nails. Your nails may change color or get more brittle. You may get lines or bands across your nails.
Call your doctor right away if you have any skin changes during treatment.
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Hair loss (alopecia)
Your hair may get thinner or even all fall out. It can happen on all parts of your body. You may start to see these changes about a week after your first treatment. Your hair will grow back after chemo.
Some people choose to wear scarves, caps, or wigs when they have hair loss. A short haircut before treatment may help make hair loss easier.
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Fluid retention
This is when fluid builds up in your tissue or spaces in the body. This includes spaces in your belly or around your lungs. Weigh yourself daily to see if you have gained weight. Your doctor may prescribe medicine to help decrease fluid retention.
Call your doctor right away if you have:
- Swelling in the feet, ankles, legs, or hands
- Gain several pounds
- Are short of breath
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Mouth sores (mucositis)
Chemo can cause sores in the mouth and throat. These can be irritating or painful. They can also lead to infection since the mouth is full of germs. It is very important to take good care of your mouth during treatment.
- Drink 6-8 glasses of fluid each day.
- Brush your teeth with a soft toothbrush or cotton swab after meals.
- Avoid mouthwash that contains alcohol.
- Use a mild mouthwash at least 4 times a day. For example: Mix 2 teaspoons of baking soda and 1 teaspoon of salt in an 8 ounce glass of warm water. Then swish it in your mouth and spit it out.
- Avoid hot, spicy or acidic foods and sharp or crunchy foods.
- Cut food into small pieces or moisten with sauces, gravy, or broth.
Call your doctor right away if you are cannot eat, drink, or take medicines because of mouth sores.
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Decreased appetite
It is very important to eat well while getting chemo. When you do not feel like eating, try some of the following tips:
- Eat small meals more often instead a few large meals.
- Keep snacks nearby. You can eat them when you do feel hungry.
- Eat a bedtime snack.
- Try liquid nutritional supplements. Examples are Ensure or Boost.
- Drink 6-8 glasses of fluid a day. Do this even if you cannot eat solid foods.
- Change the form of your food. For example, make a fruit milkshake instead of eating a piece of fruit
- Talk to a dietitian about good nutrition.
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What are some less common side effects I should know about?
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Eye changes
Busulfan can cause vision changes. These include blurry vision or problems seeing clearly. It may also cause cataracts.
Tell your doctor if you have any changes in your vision.
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Cancer
Talk to your doctor about the risk of other kinds of cancer after getting your chemo treatment.
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Lung changes
This treatment may cause changes in your lungs. These changes can range from a cough and shortness of breath to damage of your lung tissue. Your doctor may listen to your breathing to make sure your lungs are working properly.
Tell your doctor if you feel short of breath or have trouble breathing.
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Liver changes
These liver changes may be minor and last a short time. Or they can cause a lot or damage to your liver. Your doctor may order blood tests to make sure your liver is working properly.
Tell your doctor if you have pain in your belly, pass dark colored urine, the white of your eyes looks yellow, or gain or lose more than 5 pounds.
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Kidney changes
Your doctor may order blood tests or ask for a urine sample to make sure your kidneys are working right. You can help prevent kidney problems by drinking plenty of fluids.
Tell your doctor if you have pain or burning when you urinate, cannot pass urine, or notice reddish or bloody urine.
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Bladder changes
In rare cases, busulfan can damage the bladder. Drink extra fluids while getting this treatment. This will help protect your bladder.
Tell your doctor if you have red or bloody urine, stomach pain or cramps, or pain when you urinate.
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Nervous system changes
These may include vision changes (blurry vision, double vision, sensitivity to light), difficulty walking or keeping your balance, tingling or numbness in your hands or feet, headaches, confusion, or seizures. You doctor may ask you to take an anti-seizure medicine. Take it only as directed.
Tell your doctor right away if you notice any of those symptoms.
In case of seizure, make sure your family and friends know what to do.
- Call your doctor right away.
- Do not put anything in your mouth.
- Keep you safe from falling or bumping into things.
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Muscle pain (myalgia), joint pain (arthralgia), and tiredness (fatigue)
Your joints and muscles may feel tired or painful. Make sure you get enough rest during your treatment. Do not take aspirin for this pain without talking to your doctor first.
Call your doctor right away if you have any of these joint or muscle problems.
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