Severe neuropsychiatric disorder developing during busulfan-containing regimen for stem cell transplantation

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  • IMOTO Naoto
    Department of Hematology and Oncology, Toyohashi Municipal Hospital
  • FUJIWARA Shinji
    Department of Hematology and Oncology, Toyohashi Municipal Hospital Department of Hematology, Nagoya University Hospital
  • WATANABE Miki
    Department of Hematology and Oncology, Toyohashi Municipal Hospital
  • SUZUKI Yutaro
    Department of Hematology and Oncology, Toyohashi Municipal Hospital Department of Hematology, Nagoya University Hospital
  • KAWAGUCHI Takuya
    Department of Hematology and Oncology, Toyohashi Municipal Hospital Department of Hematology, Nagoya University Hospital
  • ITO Rie
    Department of Hematology and Oncology, Toyohashi Municipal Hospital
  • SAKAI Toshiyasu
    Department of Hematology and Oncology, Toyohashi Municipal Hospital Department of Hematology, Anjo kosei Hospital
  • KURAHASHI Shingo
    Department of Hematology and Oncology, Toyohashi Municipal Hospital

Bibliographic Information

Other Title
  • Busulfanを含む造血幹細胞移植前処置中に生じた重度精神障害
  • Busulfan オ フクム ゾウケツ カンサイボウ イショク マエショチ チュウ ニ ショウジタ ジュウド セイシン ショウガイ

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Abstract

<p>Here we describe two patients that required interruption of a busulfan (BU) containing conditioning regimen due to severe mental disorder before stem cell transplantation. The first patient was a 66-year-old man scheduled for unrelated peripheral blood stem cell transplantation with fludarabine/BU conditioning for myelodysplastic syndrome. He received 9.6 mg/kg BU and developed hallucinations that worsened the next day. BU was stopped on the final day, but the patient became comatose (grade 4). He recovered the next day. The second patient was a 69-year-old man scheduled for autologous peripheral blood stem cell transplantation with thiotepa (TT)/BU conditioning for cerebral nervous system relapse of mantle cell lymphoma. He received 12.8 mg/kg BU and developed hallucinations. His mental symptoms worsened on the next day, and thus administration was stopped on the second day of TT. His symptoms improved the next day. Both patients were over 65 years old, and their psychiatric symptoms worsened 1-2 days after the final dose of BU. Our findings suggest that BU may cause psychiatric disorders in elderly patients. When performing BU conditioning, it may be necessary to avoid azole antifungal medication and acetaminophen and to reduce the dose or perform therapeutic dose monitoring for elderly patients.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 64 (11), 1415-1420, 2023

    The Japanese Society of Hematology

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