Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Unreported use of an herbal supplement resulting in decreased clearance of intravenous busulfan in a patient undergoing auto-SCT

Bone Marrow Transplantation volume 49, pages 313–314 (2014)Cite this article

Subjects

Complementary and alternative medicine (CAM)—products and practices considered outside conventional medicine—are used by 25–50% of adults in developed nations, and among cancer patients its use is described as common and widespread.1 In the BMT setting, in which narrow therapeutic indexes and drug–drug interactions are commonplace, knowledge of CAM use is crucial.

We report a patient undergoing myeloablative conditioning before hematopoietic stem cell transplantation (HSCT) with a markedly decreased busulfan (BU) clearance attributed to a CAM product. The patient is a 44-year-old obese man (body mass index: 53 kg/m2) with stage-III (ISS) IgG kappa multiple myeloma. After three cycles of proteasome inhibitor-containing induction chemotherapy, he achieved a partial response per IMWG criteria without significant toxicities. Other than decreased creatinine clearance (53 mL/min) attributed to his myeloma, the pre-HSCT organ function was within normal institutional limits (total bilirubin: 0.2 mg/dL, direct bilirubin: 0.1 mg/dL, alkaline phosphatase: 56 U/L, AST: 16 U/L, ALT: 9 U/L).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Ernst E, Cassileth BR . The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 1998; 83: 777–782.

    Article  CAS  Google Scholar 

  2. Andersson BS, Thall PF, Madden T, Couriel D, Wang X, Tran HT et al. Busulfan systemic exposure relative to regimen-related toxicity and acute graft-versus-host disease: defining a therapeutic window for i.v. BuCy2 in chronic myelogenous leukemia. Biol Blood Marrow Transplant 2002; 8: 477–485.

    Article  CAS  Google Scholar 

  3. Ltd FMD Flora Flor-Essence Herbal Tea Blend Description (cited 2013 July 22). Available from http://www.florahealth.com/product_conditions_usa.cfm?conditions_id=4&prod_id=211.

  4. Leonard BJ, Kennedy DA, Cheng FC, Chang KK, Seely D, Mills E . An in vivo analysis of the herbal compound essiac. Anticancer Res 2006; 26: 3057–3063.

    PubMed  Google Scholar 

  5. Seely D, Kennedy DA, Myers SP, Cheras PA, Lin D, Li R et al. In vitro analysis of the herbal compound Essiac. Anticancer Res 2007; 27: 3875–3882.

    PubMed  Google Scholar 

  6. Lin SC, Chung TC, Lin CC, Ueng TH, Lin YH, Lin SY et al. Hepatoprotective effects of Arctium lappa on carbon tetrachloride- and acetaminophen-induced liver damage. Am J Chinese Med 2000; 28: 163–173.

    Article  CAS  Google Scholar 

  7. Guo Z, Smith TJ, Wang E, Sadrieh N, Ma Q, Thomas PE et al. Effects of phenethyl isothiocyanate, a carcinogenesis inhibitor, on xenobiotic-metabolizing enzymes and nitrosamine metabolism in rats. Carcinogenesis 1992; 13: 2205–2210.

    Article  CAS  Google Scholar 

  8. Hassan M, Oberg G, Ehrsson H, Ehrnebo M, Wallin I, Smedmyr B et al. Pharmacokinetic and metabolic studies of high-dose busulphan in adults. Eur J Clin Pharmacol 1989; 36: 525–530.

    Article  CAS  Google Scholar 

  9. Buggia I, Zecca M, Alessandrino EP, Locatelli F, Rosti G, Bosi A et al. Itraconazole can increase systemic exposure to busulfan in patients given bone marrow transplantation. GITMO (Gruppo Italiano Trapianto di Midollo Osseo). Anticancer Res 1996; 16: 2083–2088.

    CAS  PubMed  Google Scholar 

  10. Freytes CO, Toro JJ, Yeh RF, Stadtmauer EA, Ratanatharathorn V, Akpek G et al. Pharmacokinetics and safety of once-daily intravenous busulfan with bortezomib in patients with relapsed multiple myeloma undergoing a second autologous hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2012; 18: S253.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Montefiore Medical Center, Bronx, NY, USA

    J Carter, I Braunschweig & S K Barta

  2. Seattle Cancer Care Alliance Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    R F Yeh

Authors
  1. J Carter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R F Yeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I Braunschweig
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S K Barta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S K Barta.

Ethics declarations

Competing interests

Dr Barta receives research funding from Otsuka Pharmaceuticals. The remaining authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carter, J., Yeh, R., Braunschweig, I. et al. Unreported use of an herbal supplement resulting in decreased clearance of intravenous busulfan in a patient undergoing auto-SCT. Bone Marrow Transplant 49, 313–314 (2014). https://doi.org/10.1038/bmt.2013.169

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2013.169

This article is cited by

Search

Advanced search

Quick links