Multiple Myeloma
- As part of high-dose chemotherapy for autologous stem cell transplant (ASCT)
- In combination with prednisone for non-transplant patients
dose:
- Oral (non-transplant):
- 4–10 mg daily for 7–14 days; often used with prednisone
- High-dose IV (transplant conditioning):
- 100–200 mg/m² IV once, usually given with hydration and cryotherapy (to reduce mucositis)
Ovarian Cancer (palliative treatment)
- Melphalan flufenamide (a derivative) is also used in relapsed/refractory multiple myeloma
- Off-label:
- Amyloidosis, malignant melanoma, breast cancer, neuroblastoma
Dose: Oral: 6–10 mg/day for 5 days every 4–6 weeks
- Oral tablets: 2 mg (Alkeran)
- IV lyophilized powder (Evomela):
- 50 mg vials (reconstituted before use)
- Take oral melphalan on an empty stomach (food may reduce absorption)
- Store oral tablets in the refrigerator
- IV form must be prepared carefully; use within specific timeframes post-reconstitution
- Hydration and cryotherapy (ice chips) are used with high-dose IV to reduce mucositis
- Class: Alkylating agent (nitrogen mustard derivative)
- Mechanism of Action:
- Cross-links DNA strands → inhibits DNA & RNA synthesis → cell death
- Cell cycle-nonspecific
- Metabolism: Non-enzymatic hydrolysis (not heavily dependent on liver enzymes)
- Excretion: Mainly renal
- Half-life: ~1.5 hours (IV), longer intracellularly
- Nausea, vomiting
- Bone marrow suppression (especially leukopenia, thrombocytopenia)
- Fatigue
- Diarrhea or constipation
- Oral mucositis (especially with high-dose IV)
- Hair loss
- Hypersensitivity to melphalan
- Severe bone marrow suppression
- Active infection (relative contraindication without infection control)
- Pregnancy (see below)
- Live vaccines: Avoid due to immunosuppression
- Other myelosuppressive agents: Additive risk of neutropenia, thrombocytopenia
- May increase toxicity when combined with cyclosporine, carboplatin, or busulfan
Drug Status
Availability | |
Pregnancy | |
Breastfeeding | |
Schedule |
BRAND NAME | STRENGTH | FORMULATION | PACK SIZE | MANUFACTURER | DISTRIBUTOR |
---|---|---|---|---|---|
Alkeran | 2mg | Tablet | 25’s | Beta Healthcare | Beta Healthcare |
Alkeran | 5mg | Tablet | 25’s | Beta Healthcare | Beta Healthcare |