Melfalan Tillomed (Melphalan)

Melphalan is an alkylating antineoplastic agent used in the management of several malignancies.

• Multiple Myeloma: reduces malignant plasma cells and helps achieve disease control.
• Ovarian Cancer: contributes to tumor shrinkage and prolongs progression‑free survival.
• Melanoma: used in combination regimens to improve response rates.
• Breast Cancer: administered in advanced or refractory disease to limit tumor growth.

• Melphalan alkylates DNA by forming covalent cross‑links between guanine bases, which interferes with DNA replication and transcription. The resulting DNA damage triggers cell‑cycle arrest and apoptosis, preferentially affecting rapidly dividing cancer cells while sparing most normal tissues.

Melphalan may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset occurring shortly after infusion.
• Myelosuppression: decreased white blood cells, platelets, and red cells.
• Alopecia: reversible hair loss during treatment.
• Fatigue: generalized tiredness often related to anemia.
• Mucositis: inflammation of the mouth and gastrointestinal lining.
• Diarrhea: loose stools that may require supportive care.

Serious or Rare Side Effects

• Secondary leukemia: development of a new hematologic malignancy.
• Severe infections: opportunistic infections due to profound neutropenia.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis.
• Renal toxicity: impaired kidney function, especially with high cumulative doses.
• Hemorrhage: bleeding complications from thrombocytopenia.
• Anaphylactic reactions: rare hypersensitivity during infusion.

Prior to initiating therapy, clinicians should assess baseline organ function and counsel patients on potential risks.

• Monitor blood counts: perform regular CBCs to detect myelosuppression.
• Assess renal function: check serum creatinine and adjust dosing if needed.
• Evaluate hepatic status: liver enzymes should be within acceptable limits.
• Avoid in pregnancy: teratogenic risk requires effective contraception.
• Delay treatment for active infections: treat infections before continuing therapy.
• Store at ambient temperature: keep in original container, protect from light and moisture.

Melphalan can interact with other agents that affect bone‑marrow function or organ clearance.

Major Interactions (Avoid)

• Concurrent myelosuppressive chemotherapy: may cause profound pancytopenia.
• High‑dose radiation therapy: increases risk of severe tissue injury.
• Live vaccines: immunosuppression can lead to uncontrolled infection.

Moderate Interactions (Monitor Closely)

• Nephrotoxic drugs (e.g., aminoglycosides): may exacerbate renal toxicity.
• Anticoagulants (e.g., warfarin): heightened bleeding risk due to thrombocytopenia.
• Antiemetics with serotonergic activity: monitor for serotonin syndrome.
• CYP inducers (e.g., rifampin): may reduce plasma levels of melphalan.