Pharm

Melphalan

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Melphalan, Evomela, Alkeran

  • See Also
  1. Chemotherapy
  2. Alkylating Agent
  • Indications
  1. FDA Approved
    1. Multiple Myeloma
    2. Epithelial Ovarian Cancer (non-resectable)
  2. Off-Label Use
    1. Amyloidosis (light chain)
    2. Ewing Sarcoma (children, for Stem Cell Transplant)
    3. Neuroblastoma (children, for Stem Cell Transplant)
    4. Non-Hodgkin Lymphoma (for Stem Cell Transplant)
    5. Hodgkin Lymphoma (refractory)
    6. Testicular Cancer
  • Mechanism
  1. See Alkylating Agent
  2. Antineoplastic, Phenylalanine derivative of nitrogen mustard
    1. As with other Alkylating Agents (and nitrogen mustards), cross-links DNA
    2. Melphalan alkylates DNA at the N7 position of guanine
    3. Melphalan was first synthesized in 1953, and has been used in Multiple Myeloma since that time
  • Medications
  1. Alkeran IV: 50 mg/vial
  2. Alkeran Tabs: 2 mg
  3. Evomela Lypholized IV: 50 mg/vial (lypholized powder for reconstitution)
    1. Indicated for high dose regimens in Stem Cell Transplant
  • Dosing
  1. See other references for dosing protocols specific to indications
  • Adverse Effects
  1. Myelosuppression (severe)
    1. Intravenous forms result in greater Bone Marrow suppression
    2. Monitor Complete Blood Count
  2. Hypersensitivity Reactions (2% with IV preparation)
  3. Impaired future fertility
  4. Alopecia
  5. Carcinogenic
    1. Associated with secondary Leukemia risk
  • Safety
  1. Avoid in Lactation
  2. Avoid in Pregnancy (all trimesters)
    1. Use reliable Contraception
  • Resources
  1. Melphalan (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e9c2efee-173d-4795-96d8-7aae5b3a3073
  2. Evomela (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=69f55869-dc11-408e-8fc7-47634269a52c
  3. Melphalan (NIH in Carcinogenic Risk Monograph)
    1. https://www.ncbi.nlm.nih.gov/books/NBK304320/
  • References
  1. Poczta (2021) J Clin Med 10(9):1841 +PMID: 33922721 [PubMed]