Busulfan

• Does not usually come backLungs: Lung scarring from carmustine does not heal, and it can appear for the first time more than a decade after the treatment ended, especially in people treated as children. 6 of 17 survivors died of lung fibrosis, and all 8 studied later had restrictive lung function, mean vital capacity 54% of predicted (31 children treated with carmustine for brain tumours between 1972 and 1976). Late carmustine lung fibrosis, New England Journal of Medicine 1990
• Does not usually come backFertility: Busulfan used to prepare for a transplant damages the ovaries or testicles in roughly two thirds of children, and lowering the exposure did not reduce that risk. gonadal dysfunction in 35 of 56 (63%) after busulfan and 9 of 32 (28%) after treosulfan (children and adolescents transplanted for non-malignant disease between 1997 and 2018, Netherlands). Gonadal function after busulfan or treosulfan conditioning, Transplantation and Cellular Therapy 2023
• Partly comes backBlood counts and immunity: After high-dose melphalan with a stem cell transplant the killer T cells come back within about three months, but the naive T cells that let you respond to something new take about eighteen months, and in older patients they may not return at all. naive CD45RA+ CD4 T cells approached the normal range only at 18 months and only in younger patients (71 women with high-risk or metastatic breast cancer given high-dose melphalan and etoposide with autologous stem cell support). Immune reconstitution after high-dose melphalan, Biology of Blood and Marrow Transplantation 2005
• Usually comes backMouth, saliva, taste and swallowing: A sore mouth after high-dose melphalan affects about four in ten people badly, and it heals as the blood counts come back, over roughly five days. severe oral mucositis in 44% (197 patients with myeloma or non-Hodgkin lymphoma having high-dose melphalan or BEAM and an autologous transplant at 25 European centres). Prospective Oral Mucositis Audit, Bone Marrow Transplantation 2009
• Does not usually come backSkin and nails: Busulfan is one of the few drugs reported to leave hair permanently thin: in a small series the regrowth was sparse, short and altered in texture, and the scalp biopsies showed the follicles had shrunk rather than scarred. 3 patients given busulfan for acute myelogenous leukaemia within a 10-case series of permanent alopecia (clinicopathological case series, 10 patients). Permanent alopecia after systemic chemotherapy, American Journal of Dermatopathology 2011

Read for the class this product belongs to (other alkylating drugs) unless the answer names the product. Population figures from the cohorts named, not a prediction for one person. Blank where no source gives a recovery figure.