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