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 Melphalan

Melphalan (American brand Alkeran) is a chemotherapy drug commonly used to treat multiple myeloma. It belongs to drugs called alkylating agents that can inhibit the synthesis of DNA and RNA, leading to the death of dividing and undivided tumor cells. It has been used to treat MM since the 1960s.

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How it's Used

In the United States, melphalan is most commonly used to treat MM as a modulator in autologous stem cell transplantation. High-dose intravenous infusion (IV) is used to ablate (remove the place where myeloma grows) bone marrow, which is the day before the patient's own hematopoietic (hematopoietic) stem cells are restored.

The most common use outside the United States is in combination with Velcade® and prednisone (VMP), and in combination with thalidomide and prednisone (MPT) as an oral agent for the treatment of myeloma.

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Possible Side Effects

Like most traditional chemotherapeutics that kill all rapidly dividing cells in the body, intravenous injections of high-dose melphalan usually cause the following side effects:

  • nausea
  • vomiting,
  • mouth sores
  • hair loss,
  • rash
  • itching
  • infertility, and
  • Inhibits the bone marrow's ability to produce new blood cells, especially white blood cells (which may increase the risk of infection) and platelets (which may increase the risk of bleeding).
As an oral drug in low-dose combination therapy, melphalan is well tolerated and is usually used to treat elderly and frail patients.

With prolonged use, however, melphalan may result in the following conditions:

  • scarring of lung tissue (pulmonary fibrosis),
  • a severe, potentially fatal form of respiratory disease (interstitial pneumonitis),
  • cardiac arrest,
  • myelodysplasia, or
  • leukemia.
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