II. Indications
- FDA Approved
- Multiple Myeloma
- Epithelial Ovarian Cancer (non-resectable)
- Off-Label Use
- Amyloidosis (light chain)
- Ewing Sarcoma (children, for Stem Cell Transplant)
- Neuroblastoma (children, for Stem Cell Transplant)
- Non-Hodgkin Lymphoma (for Stem Cell Transplant)
- Hodgkin Lymphoma (refractory)
- Testicular Cancer
III. Mechanism
- See Alkylating Agent
- Antineoplastic, Phenylalanine derivative of nitrogen mustard
- As with other Alkylating Agents (and nitrogen mustards), cross-links DNA
- Melphalan alkylates DNA at the N7 position of guanine
- Melphalan was first synthesized in 1953, and has been used in Multiple Myeloma since that time
IV. Medications
- Alkeran IV: 50 mg/vial
- Alkeran Tabs: 2 mg
- Evomela Lypholized IV: 50 mg/vial (lypholized powder for reconstitution)
- Indicated for high dose regimens in Stem Cell Transplant
V. Dosing
- See other references for dosing protocols specific to indications
VI. Adverse Effects
- Myelosuppression (severe)
- Intravenous forms result in greater Bone Marrow suppression
- Monitor Complete Blood Count
- Hypersensitivity Reactions (2% with IV preparation)
- Impaired future fertility
- Alopecia
- Carcinogenic
- Associated with secondary Leukemia risk
VII. Safety
- Avoid in Lactation
- Avoid in Pregnancy (all trimesters)
- Use reliable Contraception
VIII. Resources
- Melphalan (DailyMed)
- Evomela (DailyMed)
- Melphalan (NIH in Carcinogenic Risk Monograph)