II. 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

III. 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

IV. 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

V. Dosing

  1. See other references for dosing protocols specific to indications

VI. 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

VII. Safety

  1. Avoid in Lactation
  2. Avoid in Pregnancy (all trimesters)
    1. Use reliable Contraception

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