Carmustine Accord (Carmustine)
Nitrosourea alkylating agent for brain tumors, lymphoma, and other malignancies
Quick Facts About Carmustine Accord
Key Takeaways About Carmustine Accord
- Crosses the blood-brain barrier: Carmustine's high lipophilicity enables it to penetrate the central nervous system, making it one of the few chemotherapy agents effective against brain tumors
- Delayed bone marrow suppression: Unlike most chemotherapy drugs, carmustine's most dangerous side effect—myelosuppression—typically appears 4–6 weeks after treatment, requiring prolonged monitoring
- Six-week treatment cycles: Due to delayed toxicity, doses are given no more frequently than every 6 weeks, and only after blood counts have recovered
- Pulmonary toxicity risk: Carmustine can cause serious, potentially fatal lung damage (pulmonary fibrosis) that may develop even years after the last dose
- Contains ethanol: The solvent used for reconstitution contains alcohol, which may affect patients with epilepsy, liver disease, or alcohol dependency
What Is Carmustine Accord and What Is It Used For?
Carmustine Accord is a chemotherapy medication containing carmustine (BCNU), a nitrosourea alkylating agent. It is used in adults to treat brain tumors, lymphoma, gastrointestinal cancers, malignant melanoma, and as high-dose conditioning before autologous stem cell transplantation.
Carmustine is one of the most established chemotherapy agents used in neuro-oncology and hematological malignancy treatment. First developed in the 1960s and approved by regulatory agencies worldwide, it remains a cornerstone of treatment for several types of cancer due to its unique ability to cross the blood-brain barrier. This property distinguishes carmustine from many other chemotherapy drugs that cannot effectively reach tumors within the central nervous system.
The drug belongs to the nitrosourea class of alkylating agents. These medications work by attaching chemical groups (alkyl groups) to the DNA of cancer cells, creating cross-links between the two strands of the DNA double helix. This cross-linking prevents the DNA from being properly copied when the cell attempts to divide, ultimately leading to cell death. Additionally, carmustine inhibits several key enzymatic processes involved in DNA repair through a mechanism called carbamoylation of proteins, which further enhances its anticancer activity.
Carmustine is highly lipophilic (fat-soluble), which allows it to readily dissolve in fatty tissue and cross biological membranes, including the blood-brain barrier. The blood-brain barrier is a selective membrane that protects the brain from harmful substances circulating in the bloodstream but also prevents many medications from reaching brain tissue. Because carmustine can penetrate this barrier, it achieves therapeutic concentrations within the brain and central nervous system, making it invaluable for treating brain tumors and brain metastases from other cancers.
Approved Indications
Carmustine Accord is approved for use in adults, either as a single agent or in combination with other anticancer drugs and therapeutic measures (radiation therapy, surgery), for the following conditions:
- Brain tumors: Glioblastoma multiforme, brainstem glioma, medulloblastoma, astrocytoma, and ependymoma. These are among the most challenging cancers to treat due to their location within the brain
- Brain metastases: Secondary tumors that have spread to the brain from cancers originating elsewhere in the body
- Hodgkin lymphoma: As second-line therapy when initial treatment has not achieved adequate response. Carmustine is a key component of the BEAM conditioning regimen (carmustine, etoposide, cytarabine, melphalan) used before stem cell transplantation
- Non-Hodgkin lymphoma: Also as second-line treatment in patients whose disease has relapsed or is refractory to first-line therapy
- Gastrointestinal tumors: Certain cancers of the stomach, intestines, and digestive system
- Malignant melanoma: An aggressive form of skin cancer that can metastasize to various organs
- Conditioning before stem cell transplantation: At high doses (up to 600 mg/m²), carmustine is used as part of conditioning regimens before autologous hematopoietic stem cell transplantation (HSCT) in patients with hematological malignancies
One of the most well-known uses of carmustine is in the BEAM regimen (carmustine, etoposide, cytarabine, melphalan), which is a standard high-dose chemotherapy conditioning protocol used before autologous stem cell transplantation in patients with Hodgkin and non-Hodgkin lymphoma. According to the National Comprehensive Cancer Network (NCCN) guidelines, BEAM remains the most commonly used conditioning regimen for lymphoma patients undergoing transplantation.
Carmustine Accord is manufactured by Accord Healthcare B.V., based in the Netherlands, and is one of several commercially available formulations of carmustine. Other brand names for carmustine products include Carmustine medac. All formulations contain the same active substance and are used for the same indications.
What Should You Know Before Taking Carmustine Accord?
Before receiving Carmustine Accord, your doctor will assess your blood counts, liver function, kidney function, and lung function. The drug must not be used in patients with severe bone marrow suppression, severe kidney impairment, children under 18, or women who are breastfeeding. Fertile patients of both sexes must use effective contraception.
Carmustine is a potent chemotherapy agent with significant potential for serious side effects. A thorough medical evaluation is essential before treatment begins to ensure the drug can be administered safely and to establish baseline measurements for monitoring during therapy. Your healthcare team will carefully weigh the expected benefits against the risks for your individual situation.
Contraindications
You must not receive Carmustine Accord if any of the following apply:
- Allergy to carmustine or any other ingredient in the formulation (including the ethanol solvent)
- Bone marrow suppression: If you have suppressed blood cell production in the bone marrow and your platelet, white blood cell (leukocyte), or red blood cell (erythrocyte) counts are reduced, whether from previous chemotherapy or other causes
- Severe kidney impairment: Patients with severely reduced kidney function cannot safely metabolize and excrete carmustine
- Children and adolescents: Carmustine Accord must not be given to patients under 18 years of age
- Breastfeeding: You must not breastfeed during treatment or for at least 7 days after the last dose
Warnings and Precautions
Talk to your doctor, pharmacist, or nurse before receiving Carmustine Accord. Several important warnings apply to this treatment:
Delayed myelosuppression is the most common and potentially life-threatening side effect of carmustine. Unlike most chemotherapy agents where blood count changes appear within 1–2 weeks, carmustine causes a characteristic delayed reduction in blood cells that typically reaches its lowest point (nadir) at 4–6 weeks after administration. This can manifest as unusual tiredness, bleeding from skin and mucous membranes, frequent infections, and fever. For this reason, your doctor will monitor your blood values every week for at least 6 weeks after each dose.
Pulmonary toxicity is another serious concern. Before treatment begins, you will undergo chest X-rays and pulmonary function tests. Carmustine can cause lung damage that may develop during treatment or even several years later. The risk increases with cumulative doses, particularly when the total lifetime dose exceeds 1,400 mg/m². Symptoms include persistent cough, shortness of breath, and chest pain. You should report any respiratory symptoms to your doctor immediately, even if they occur long after treatment has ended.
Liver and kidney function will be tested before treatment and monitored regularly throughout your course of therapy. Carmustine can cause liver damage, including elevated liver enzymes and bilirubin levels. In rare cases, it can cause veno-occlusive disease, a serious condition in which small veins in the liver become blocked. Kidney function may also be affected, and dose adjustments may be necessary if your glomerular filtration rate is reduced.
High-dose treatment with carmustine (up to 600 mg/m²) is only given in combination with subsequent stem cell transplantation. Higher doses increase the frequency and severity of pulmonary, renal, hepatic, and cardiac toxicity, as well as gastrointestinal complications, infections, and electrolyte imbalances (low blood levels of potassium, magnesium, and phosphate).
Carmustine can cause serious and potentially fatal lung damage (pulmonary fibrosis). This can occur during treatment or even years after the last dose. Contact your doctor immediately if you develop shortness of breath, persistent cough, chest pain, or unexplained fatigue. The risk is dose-dependent and increases with cumulative lifetime exposure.
Pregnancy and Breastfeeding
Carmustine Accord must not be used during pregnancy as it can cause harm to the developing fetus. Animal studies have demonstrated that carmustine is teratogenic (capable of causing birth defects) and embryotoxic. If you are pregnant, think you may be pregnant, or are planning to have a baby, consult your doctor before receiving this medicine.
- Women of childbearing potential must use effective contraception to avoid becoming pregnant during treatment and for at least 6 months after the last dose
- Male patients must use appropriate contraception during treatment and for at least 6 months afterward to prevent their partner from becoming pregnant
- Breastfeeding is contraindicated during treatment and for at least 7 days after the last dose, as a risk to the newborn or infant cannot be excluded
- Fertility: Carmustine may cause infertility in both men and women. Discuss fertility preservation options with your healthcare team before starting treatment
Driving and Operating Machinery
Carmustine Accord itself has no or negligible direct effect on the ability to drive or use machines. However, the ethanol content of the medicine may impair your ability to drive or operate machinery. The maximum dose (600 mg/m²) contains a significant amount of alcohol equivalent to approximately 640 mL of beer or 256 mL of wine. Because the infusion is delivered slowly over 1–2 hours, the effects of alcohol may be somewhat reduced. You are responsible for assessing whether you are fit to drive or perform tasks requiring alertness after treatment.
Alcohol Content
Carmustine Accord contains 2.37 g of alcohol (ethanol) per vial, corresponding to approximately 33.86 mg/kg body weight. This is an important consideration in the following situations:
- If you have epilepsy or liver problems, talk to your doctor before receiving this medicine
- If you have a history of alcohol dependency, inform your doctor before treatment
- The alcohol content may alter the effect of other medications you are taking
- If you are pregnant, the alcohol content represents an additional risk factor for the fetus
How Does Carmustine Accord Interact with Other Drugs?
Carmustine interacts with several medications including phenytoin, cimetidine, digoxin, dexamethasone, and melphalan. The combination with melphalan is particularly concerning as it significantly increases pulmonary toxicity risk. The ethanol solvent may also alter the effects of other medications.
Drug interactions are an important consideration when using carmustine, as they can affect both the efficacy of treatment and the risk of side effects. It is essential to inform your doctor about all medications you are currently taking, have recently taken, or may plan to take, including prescription drugs, over-the-counter medicines, and herbal supplements.
Major Interactions
| Interacting Drug | Therapeutic Use | Effect of Interaction | Recommendation |
|---|---|---|---|
| Phenytoin | Epilepsy treatment | Carmustine may reduce phenytoin plasma levels, potentially reducing seizure control | Monitor phenytoin levels closely; dose adjustment may be needed |
| Cimetidine | Gastric acid reduction | May enhance bone marrow suppressive effects of carmustine | Consider alternative acid suppressant; monitor blood counts more frequently |
| Melphalan | Cancer treatment | Significantly increases the risk of severe pulmonary toxicity | Use combination with extreme caution; enhanced lung monitoring required |
| Dexamethasone | Anti-inflammatory / immunosuppressant | May affect carmustine metabolism and therapeutic efficacy | Inform your doctor; dosing may need coordination |
| Digoxin | Heart rhythm disorders | Carmustine may reduce digoxin absorption and plasma levels | Monitor digoxin levels; dose adjustment may be necessary |
Minor Interactions
In addition to the major interactions listed above, the following considerations apply:
- Other myelosuppressive agents: Any medication that suppresses bone marrow function will have additive effects when combined with carmustine, potentially worsening blood count reductions. This includes many other chemotherapy drugs, certain antibiotics, and some immunosuppressants
- Alcohol-containing medications: Because Carmustine Accord itself contains ethanol, the total alcohol intake from all sources should be considered, particularly when other alcohol-containing medications are being administered concurrently
- Live vaccines: Immunosuppressed patients should not receive live vaccines during or shortly after chemotherapy, as the weakened immune system may allow the vaccine virus to cause actual disease
- Nephrotoxic drugs: Medications that can damage the kidneys (such as certain antibiotics, NSAIDs, and contrast agents) should be used cautiously alongside carmustine, as this combination may increase the risk of kidney damage
When carmustine is used as part of combination chemotherapy regimens such as BEAM (carmustine, etoposide, cytarabine, melphalan), all drugs in the regimen will have overlapping toxicities. Your oncology team will carefully time and dose each agent to minimize cumulative side effects while maintaining treatment efficacy. Close monitoring of blood counts, organ function, and overall clinical status is essential throughout the treatment course.
What Is the Correct Dosage of Carmustine Accord?
The standard dose of Carmustine Accord as monotherapy is 150–200 mg/m² intravenously every 6 weeks, given either as a single dose or divided over 2 days. For conditioning before stem cell transplantation, doses of 300–600 mg/m² are used. All doses are adjusted based on blood count recovery.
Carmustine Accord is exclusively administered by healthcare professionals experienced in the use of anticancer medications. Dosing is individualized based on your medical condition, body surface area, previous treatments, blood count recovery, and overall organ function. The drug is never self-administered and requires specialized preparation and monitoring.
Adults – Standard Dosing
Monotherapy: 150–200 mg/m² IV every 6 weeks
The recommended dose of Carmustine Accord as single-agent therapy for previously untreated patients is 150 to 200 mg/m² administered intravenously every 6 weeks. This can be given as:
- A single dose of 150–200 mg/m² on day 1
- Divided doses of 75–100 mg/m² on two consecutive days
When given in combination with other chemotherapy agents, the dose is typically reduced accordingly.
High-Dose Conditioning Before Stem Cell Transplantation
HSCT Conditioning: 300–600 mg/m² IV
For conditioning before autologous hematopoietic stem cell transplantation (HSCT) in patients with hematological malignancies (Hodgkin and non-Hodgkin lymphoma), carmustine is given in combination with other chemotherapy agents at a dose of 300–600 mg/m² intravenously. This high-dose treatment is only performed in specialized transplant centers with immediate access to stem cell rescue.
Dose Adjustments
Treatment with carmustine must not be repeated until circulating blood components have returned to acceptable levels. The following criteria must typically be met before retreatment:
- Platelets above 100,000/mm³
- White blood cells (leukocytes) above 4,000/mm³
Blood values must be monitored at frequent intervals, and repeat treatment should not be given before 6 weeks due to the delayed hematological toxicity characteristic of carmustine.
| Leukocytes (/mm³) | Platelets (/mm³) | Percentage of Previous Dose |
|---|---|---|
| > 4,000 | > 100,000 | 100% |
| 3,000–3,999 | 75,000–99,999 | 100% |
| 2,000–2,999 | 25,000–74,999 | 70% |
| < 2,000 | < 25,000 | 50% |
If the nadir values for leukocytes and platelets do not fall on the same row in the table (for example, leukocytes > 4,000 but platelets < 25,000), the lowest percentage should be applied. There are no time limits for treatment with carmustine; however, treatment must be discontinued if the tumor does not respond or if serious or intolerable side effects develop.
Elderly Patients
Elderly: Start at the Lower End of the Dosing Range
Dose selection for elderly patients should generally be cautious, usually starting at the lower end of the dosing range. This reflects the greater frequency of decreased liver, kidney, or heart function, and the higher likelihood of concurrent diseases or other medication use. Since elderly patients are more likely to have impaired kidney function, the glomerular filtration rate should be monitored and the dose reduced accordingly.
Patients with Kidney Impairment
In patients with reduced kidney function, the dose of Carmustine Accord should be lowered based on the glomerular filtration rate. Your doctor will determine the appropriate dose reduction based on your individual kidney function tests.
Administration
Carmustine Accord is given as an intravenous drip (infusion) over 1 to 2 hours, protected from light. The infusion should last at least one hour to prevent burning sensations and pain at the injection site. The injection site will be monitored throughout the administration.
The preparation process involves several steps:
- Dissolve the 100 mg powder in 3 mL of the supplied sterile ethanol solvent
- Add 27 mL of sterile water for injection to create a 30 mL stock solution (3.3 mg/mL)
- Dilute the stock solution in 500 mL of sodium chloride 0.9% or glucose 5% solution
- Administer immediately via intravenous drip over 1–2 hours, protected from light
The intravenous solution is unstable in polyvinyl chloride (PVC) containers. All plastic that comes into contact with the carmustine infusion solution (including infusion sets) must be PVC-free polyethylene plastic; otherwise, glass equipment must be used.
Overdose
Since carmustine is administered exclusively by healthcare professionals, overdose is unlikely. However, if an overdose occurs, the primary expected complications would be severe and prolonged bone marrow suppression, liver toxicity, and potentially fatal pulmonary damage. There is no specific antidote for carmustine overdose. Treatment would be supportive, focusing on blood count monitoring, infection prevention, and organ support as needed.
What Are the Side Effects of Carmustine Accord?
The most common side effects of Carmustine Accord include delayed myelosuppression (low blood counts), nausea and vomiting, lung damage, and phlebitis (vein inflammation) at the infusion site. Serious but less common effects include secondary leukemia, encephalopathy, veno-occlusive disease, and pulmonary fibrosis. Blood counts must be monitored weekly for at least 6 weeks after each dose.
Like all chemotherapy drugs, Carmustine Accord can cause side effects, although not every patient will experience all of them. The nature, severity, and timing of side effects depend on the dose administered, the number of treatment cycles, combination with other drugs, and individual patient factors. Understanding the potential side effects and their warning signs is crucial for early detection and management.
Contact your doctor or nurse immediately if you notice any of the following: sudden wheezing, difficulty breathing, swelling of the eyelids, face, or lips, skin rash or itching (especially affecting the whole body), or feeling faint. These may be signs of a serious allergic reaction.
Very Common (affects more than 1 in 10 patients)
- Delayed myelosuppression: Reduced blood cell production in bone marrow, typically reaching nadir at 4–6 weeks, increasing risk of infections, bleeding, and anemia
- Ataxia: Lack of voluntary coordination of muscle movements
- Dizziness and headache
- Eye effects: Transient eye redness, blurred vision due to retinal hemorrhage
- Hypotension: Low blood pressure
- Phlebitis: Inflammation of veins at the infusion site, associated with pain, swelling, redness, and tenderness
- Pulmonary disease: Lung-related problems with breathing difficulties, persistent cough, or chest pain
- Severe nausea and vomiting
- Skin inflammation (dermatitis) when applied topically; accidental skin contact may cause temporary hyperpigmentation
Common (affects up to 1 in 10 patients)
- Secondary leukemia and bone marrow dysplasia: Abnormal development of bone marrow cells that may manifest as bleeding gums, bone pain, fever, recurring infections, nosebleeds, enlarged lymph nodes, pale skin, shortness of breath, or persistent fatigue
- Anemia: Decreased red blood cell count causing tiredness and weakness
- Encephalopathy: Brain disease with symptoms including muscle weakness, difficulty concentrating, involuntary twitching, tremors, difficulty speaking or swallowing, and seizures
- Loss of appetite (anorexia)
- Constipation
- Diarrhea
- Mouth and lip inflammation (stomatitis)
- Reversible liver toxicity: May cause elevated liver enzymes and bilirubin levels (detected through blood tests), particularly at high doses
- Hair loss (alopecia)
- Skin redness (erythema)
- Injection site reactions
Rare (affects up to 1 in 1,000 patients)
- Veno-occlusive disease: Progressive blockage of microscopic veins in the liver, which may cause abdominal fluid accumulation, enlarged spleen, severe esophageal bleeding, and yellowing of the skin and eyes
- Interstitial pulmonary fibrosis: Breathing difficulties caused by lung scarring (may occur even at lower doses)
- Kidney problems: Renal impairment that may require dose adjustment or treatment discontinuation
- Gynecomastia: Breast enlargement in male patients
Not Known (frequency cannot be estimated from available data)
- Muscle pain (myalgia)
- Seizures including status epilepticus
- Tissue damage resulting from leakage at the injection site (extravasation)
- Signs of infection
- Infertility
- Electrolyte abnormalities: Low blood levels of potassium, magnesium, and phosphate
- Neutropenic enterocolitis: Abdominal pain as a side effect of chemotherapy-induced neutropenia
A hallmark characteristic of carmustine toxicity is the delayed onset of myelosuppression. While many chemotherapy drugs cause blood count reductions within 7–14 days, carmustine typically causes its most severe bone marrow effects at 4–6 weeks after administration. This is why treatment cycles are spaced at least 6 weeks apart and why weekly blood monitoring is essential throughout this period. Pulmonary toxicity can have an even longer latency, appearing months or years after the last dose.
How Should You Store Carmustine Accord?
Carmustine Accord must be stored refrigerated at 2–8°C, protected from light. The reconstituted solution is stable for 24 hours at 2–8°C. After dilution, the infusion solution is stable for 4 hours at room temperature or 24 hours refrigerated plus 3 additional hours at room temperature, all protected from light.
Proper storage of Carmustine Accord is essential to maintain the stability and safety of the medication. As a hospital-administered drug, storage is managed by healthcare professionals, but understanding the requirements helps ensure the integrity of your treatment. Carmustine is sensitive to both temperature and light, and improper storage can lead to degradation of the active substance.
Unopened Vials
- Store and transport at 2°C to 8°C (refrigerated)
- Keep the vials in the outer carton to protect from light
- Do not use after the expiry date printed on the label and carton
- Keep out of the sight and reach of children
Storage of carmustine at temperatures above 28°C can cause the substance to melt, since carmustine has a very low melting point (approximately 28.0–29.0°C). An oily film visible on the bottom of the vial when inspected under strong light is a sign of decomposition. Such vials must not be used. The presence of flakes with sharp edges and solid mass in unopened vials is normal and does not indicate degradation.
After Reconstitution
- The reconstituted stock solution is stable for 24 hours at 2–8°C
- Should be diluted immediately after reconstitution
After Dilution
- Stable for 4 hours at 20–25°C, protected from light
- Or stable for 24 hours at 2–8°C plus 3 additional hours at 20–25°C, protected from light
- The 24-hour storage period for the final diluted solution is the total time carmustine is in solution, including the reconstitution period
- From a microbiological standpoint, the product should be used immediately unless reconstitution and dilution were performed under conditions that exclude microbial contamination
- The solution must be protected from light until administration is complete
What Does Carmustine Accord Contain?
Each vial contains 100 mg of carmustine as a powder with no excipients. The solvent vial contains 3 mL of anhydrous ethanol. After reconstitution and dilution, the stock solution provides 3.3 mg of carmustine per mL in 10% ethanol.
Carmustine Accord is provided as a powder and solvent for concentrate for solution for infusion. Understanding the composition helps healthcare professionals safely prepare and administer the medication.
Active Substance
Each 30 mL amber glass vial of powder contains 100 mg carmustine. The powder itself contains no excipients (inactive ingredients)—it is pure carmustine presented as light yellow dry flakes or a dry solidified mass.
Solvent
Each 5 mL clear glass vial of solvent contains 3 mL of anhydrous ethanol. This sterile ethanol solution is used as the initial solvent to dissolve the carmustine powder before further dilution with sterile water.
Reconstituted Solution
After dissolving the powder in the ethanol solvent and adding 27 mL of sterile water for injection, the resulting 30 mL stock solution contains 3.3 mg carmustine per mL in approximately 10% ethanol, with a pH of 4.0 to 6.8. This stock solution appears as a yellowish solution that is practically free from visible particles.
Packaging
Carmustine Accord is available in the following pack sizes:
- 1 vial of 100 mg powder + 1 vial of 3 mL solvent
- 10 vials of 100 mg powder + 10 vials of 3 mL solvent
Not all pack sizes may be marketed in every country. The powder vial is sealed with a grey bromobutyl rubber stopper and aluminium seal with a polypropylene cap. The solvent vial is sealed with a fluorotec-coated butyl rubber stopper with an aluminium seal with a polypropylene cap.
Frequently Asked Questions About Carmustine Accord
Carmustine Accord is a chemotherapy medication used to treat brain tumors (glioblastoma, astrocytoma, medulloblastoma, ependymoma), brain metastases, Hodgkin's lymphoma, non-Hodgkin's lymphoma, gastrointestinal tumors, and malignant melanoma. It is also used as high-dose conditioning therapy before autologous stem cell transplantation in patients with hematological malignancies. It can be used alone or in combination with other anticancer drugs, radiation therapy, or surgery.
The most serious side effects include delayed myelosuppression (bone marrow suppression) appearing 4–6 weeks after treatment, potentially fatal pulmonary fibrosis that can occur even years after therapy, liver toxicity including veno-occlusive disease, kidney damage, and secondary leukemia. Severe allergic reactions including anaphylaxis can also occur. Blood counts must be monitored weekly for at least 6 weeks after each dose.
Carmustine Accord is given as an intravenous infusion over 1 to 2 hours. The powder must first be dissolved in the supplied ethanol solvent and sterile water, then diluted in 500 mL of sodium chloride 0.9% or glucose 5% solution. The infusion must be protected from light and should last at least one hour to prevent burning and pain at the injection site. Only PVC-free polyethylene or glass containers should be used for preparation and administration.
At standard doses (150–200 mg/m²), carmustine is given no more frequently than every 6 weeks. This long interval is necessary because of the delayed bone marrow suppression that characterizes nitrosourea agents. The dose may be adjusted based on blood count recovery and the patient's response. Treatment should not be repeated until white blood cells exceed 4,000/mm³ and platelets exceed 100,000/mm³.
Yes, carmustine is highly lipophilic (fat-soluble), which allows it to readily cross the blood-brain barrier. This property makes it particularly valuable for treating brain tumors and central nervous system malignancies, where many other chemotherapy agents cannot reach effective concentrations. This is one of the key reasons carmustine remains an important option in neuro-oncology despite being developed decades ago.
Yes, Carmustine Accord contains 2.37 g of ethanol (alcohol) per vial as the solvent. The maximum dose of 600 mg/m² can deliver a significant amount of alcohol equivalent to approximately 640 mL of beer or 256 mL of wine. This is important for patients with epilepsy, liver disease, or alcohol dependency. The slow infusion over 1–2 hours helps reduce the impact of the alcohol content.
References
- European Medicines Agency (EMA). Carmustine Accord – Summary of Product Characteristics. www.ema.europa.eu
- U.S. Food and Drug Administration (FDA). BiCNU (carmustine) – Prescribing Information. www.fda.gov
- National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Central Nervous System Cancers. Version 2.2025. www.nccn.org
- National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Hodgkin Lymphoma. Version 1.2025. www.nccn.org
- Weller M, van den Bent M, Preusser M, et al. EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood. Nat Rev Clin Oncol. 2021;18(3):170-186. doi:10.1038/s41571-020-00447-z
- British National Formulary (BNF). Carmustine. National Institute for Health and Care Excellence (NICE). bnf.nice.org.uk
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. 2023. www.who.int
- Reithmeier T, Graf E, Serber T, et al. BCNU for recurrent glioblastoma multiforme: efficacy, toxicity and prognostic factors. BMC Cancer. 2010;10:30. doi:10.1186/1471-2407-10-30
- Schmitz N, Pfistner B, Sextro M, et al. Aggressive conventional chemotherapy compared with high-dose chemotherapy with autologous haemopoietic stem-cell transplantation for relapsed chemosensitive Hodgkin's disease. Lancet. 2002;359(9323):2065-2071. doi:10.1016/S0140-6736(02)08938-9
- O'Driscoll BR, Hasleton PS, Taylor PM, Poulter LW, Gattamaneni HR, Woodcock AA. Active lung fibrosis up to 17 years after chemotherapy with carmustine (BCNU) in childhood. N Engl J Med. 1990;323(6):378-382. doi:10.1056/NEJM199008093230604
Editorial Team
This article was written by the iMedic Medical Editorial Team and reviewed by specialists in hematology-oncology. All content follows the GRADE evidence framework and is based on current international guidelines from the EMA, FDA, NCCN, and WHO.
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