Melphalan

Indications

Melphalan is an anticancer (chemotherapy) medicine. It is used to treat multiple myeloma (a cancer of plasma cells in the bone marrow) and, less often, advanced ovarian cancer and some other cancers. In high doses by injection it is also used before a stem cell (bone marrow) transplant.

How It Works

Melphalan belongs to a group called alkylating agents. It attaches to the DNA inside cells and links its strands together, so the cells cannot copy their DNA and divide. Cancer cells divide quickly and are therefore strongly affected, but some healthy fast-dividing cells, such as those in the bone marrow, are affected too.

Dosage and Administration

Melphalan is given only under the care of a cancer specialist, and the dose is worked out for each patient (often from body weight or body surface area, blood counts and kidney function). Take tablets exactly as prescribed, usually on an empty stomach, swallowed whole and not broken or crushed. The injection is given into a vein by a doctor or nurse in hospital. Regular blood tests are needed throughout treatment.

Interactions

• Live vaccines (such as oral polio, measles or yellow fever vaccines) must be avoided during and after treatment.
• Ciclosporin with high-dose Melphalan can increase the risk of kidney damage.
• Nalidixic acid has been linked to serious bowel inflammation in children given Melphalan injection.
• Other medicines that suppress the bone marrow, including other chemotherapy and Clozapine, add to the risk of low blood counts.

Contraindications

• Previous allergy to Melphalan.
• Pregnancy and breastfeeding.
• Severe bone marrow failure, unless the specialist decides otherwise.

Side Effects

Common effects are low blood counts (raising the risk of infection, bleeding and anaemia), nausea, vomiting, diarrhoea, mouth sores and hair thinning or loss. It can cause infertility, early menopause and lung scarring. Long-term use slightly increases the risk of leukaemia and other second cancers.

Get urgent medical help if you have a fever of 38°C or above, chills or other signs of infection, unusual bleeding or bruising, black stools, blood in urine, severe mouth sores that stop you eating or drinking, shortness of breath or cough, or signs of an allergic reaction such as rash, swelling of the face or difficulty breathing.

Pregnancy and Lactation

Melphalan can harm an unborn baby. It must not be used in pregnancy unless the specialist decides the benefit clearly outweighs the risk. Both women and men should use reliable contraception during treatment and for several months afterwards, as advised by the doctor. Do not breastfeed while taking it.

Precautions and Warnings

Blood counts will be checked before each course. Tell your doctor about kidney problems, as the dose may need to be lowered. Avoid people with infections, keep good mouth hygiene and do not receive live vaccines. Ask about fertility preservation (such as sperm banking) before starting. This is a cytotoxic medicine: carers should avoid touching tablets with bare hands and should wash hands after handling.

Overdose

Overdose can cause severe vomiting, diarrhoea, mouth and gut damage and dangerous falls in blood counts. Go to hospital immediately. There is no specific antidote; treatment is supportive and may include blood transfusions and treatment of infection.

Therapeutic Class

Antineoplastic agent; alkylating agent (nitrogen mustard type).

Storage

Store as directed on the pack. Tablets are usually kept in a refrigerator at 2 to 8°C in the original container, and the injection vials are kept below 30°C, protected from light. Keep out of the reach of children.