Occasionally convulsions occur due to busulphan, your child will be given a medication called clonazepam for four days during the time the busulphan is given to reduce this risk. Clonazepam may make your child sleepy and the dose may be reduced. Busulphan can increase the risk of your child developing a potentially serious liver disorder called venoocclusive disease, which is mentioned in more detail in the accompanying leaflet. There is an increased risk of lung damage associated with busulphan and a possibility of developing inflammation of the lungs (pneumonitis). Your child’s skin may become darker in some places (e.g. in areas such as skin creases) or could become patchy in appearance, due to an increase in skin pigment. However, this is usually only temporary.
The busulphan is given to your child either by mouth or naso-gastric tube into the stomach and it will be given at 8.00 am and 8.00 pm for four days. It is important to inform the nursing staff if your child vomits within the hour following their dose of busulphan and you should not attempt to clean up, nursing staff will do this using protective measures. Blood levels of the busulphan will be taken every half an hour on the first day of treatment; these will be taken from your child’s central line and shouldn’t cause any distress.
Malaise, fatigue and chills are sometimes experienced with fludarabine. Nausea and vomiting can also occur, but is less common. We aim to prevent or minimise this with appropriate antisickness medication, which will be given before the fludarabine and continued after. Your child’s liver function may also be affected. Fludarabine will be given into your child’s central line over 30 minutes.
Nausea and vomiting can occur due to the high doses of cyclophosphamide that are given for bone marrow transplant conditioning. We aim to prevent or minimise this with appropriate anti-sickness medication, which will be given before the cyclophosphamide begins and will continue after. Cyclophosphamide can cause damage to the bladder lining (haemorrhagic cystitis) and to help prevent this, extra fluid is given for three hours prior to its administration, during administration and for the 24 hours following. A medication called Mesna is given continuously during the treatment and for the 24 hours following the treatment. This medication can help prevent damage to the bladder. Your child's urine will be monitored for the presence of blood and any symptoms of cystitis should be reported to the nurse looking after your child, e.g. pain/stinging sensation when passing urine, or any cloudiness of their urine. During the time the cyclophosphamide is given, your child may experience nasal stuffiness/sneezing, a metallic taste in the mouth and may occasionally suffer from watery eyes. The cyclophosphamide is given into your child’s central line over one hour on each day that it is prescribed.
Kidney damage rarely occurs with melphalan and extra fluids are given in the three hours before the melphalan and for 24 hours after the dose, to reduce this risk. Nausea and vomiting is severe and immediate with melphalan. We aim to prevent or minimise this with appropriate anti-sickness medication, which will be given before the melphalan is given and will continue after. There is a risk of lung damage associated with melphalan and a possibility of developing inflammation of the lungs (pneumonitis). Rare complications include veno-occlusive disease, which is mentioned in more detail above. Melphalan will be given into your child’s central line over three minutes.
Methotrexate is used in the prevention of Graft versus host disease. Side effects can include skin rashes, mild nausea and vomiting and mucositis. If your child is suffering from severe mucositis a dose of methotrexate may not be given. Occasionally, methotrexate can cause liver, lung or renal problems, although it is unusual for these to be a major problem. Methotrexate will be given into your child’s central line over three minutes.