Melfalan Tillomed (Melphalan)

Melphalan is an alkylating antineoplastic agent used to treat cancers that are sensitive to DNA cross‑linking therapy.

• Multiple myeloma: helps achieve disease control and prolong survival in eligible patients.
• Ovarian cancer: used as part of combination regimens to reduce tumour burden.
• Malignant melanoma: applied in selected cases to induce tumour regression when other therapies are unsuitable.

• Melphalan acts as a bifunctional alkylating agent that forms covalent cross‑links between DNA strands. By binding to the N7 position of guanine bases, it interferes with DNA replication and transcription, triggering cell‑cycle arrest at the G2/M phase and ultimately leading to apoptosis of rapidly dividing cancer cells.

Adverse reactions to melphalan vary in frequency and severity.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset commonly reported during treatment.
• Bone‑marrow suppression: decreased white blood cells, platelets, and red cells.
• Alopecia: reversible hair loss affecting scalp and body hair.
• Fatigue: persistent tiredness not relieved by rest.
• Mucositis: inflammation of the mouth and gastrointestinal lining.

Serious or Rare Side Effects

• Secondary malignancies: risk of developing new cancers after prolonged exposure.
• Severe infection: opportunistic infections due to profound neutropenia.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis.
• Renal toxicity: acute kidney injury in susceptible individuals.
• Hemorrhagic cystitis: bladder irritation and bleeding.
• Life‑threatening myelosuppression: pancytopenia requiring transfusion support.

When using melphalan, clinicians should observe several safety measures.

• Monitor blood counts: perform regular complete blood count tests to detect myelosuppression.
• Assess renal function: check serum creatinine and adjust dosing in renal impairment.
• Evaluate hepatic function: liver enzymes should be monitored before and during therapy.
• Avoid use in patients with known hypersensitivity to melphalan or related compounds.
• Contraception: both male and female patients should use effective contraception during treatment and for a defined period afterward.
• Store at ambient temperature: keep in the original container, protect from moisture and direct light.

Melphalan may interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Concurrent myelosuppressive agents (e.g., high‑dose methotrexate): can cause severe bone‑marrow toxicity.
• Live viral vaccines: increased risk of vaccine‑derived infection due to immunosuppression.

Moderate Interactions (Monitor Closely)

• NSAIDs: may exacerbate renal toxicity.
• Warfarin: melphalan can potentiate anticoagulant effects, requiring INR monitoring.
• Allopurinol: may increase risk of hypersensitivity reactions.
• ACE inhibitors: potential for additive renal impairment.
• Anticonvulsants (e.g., phenytoin): may alter melphalan metabolism.