Melfalán Hikma (Melphalan)

Melphalan is an alkylating chemotherapy used in several malignant disease groups.

• Multiple myeloma: incorporated into conditioning regimens or combination therapy to eradicate malignant plasma cells.
• Ovarian cancer: administered as part of high‑dose chemotherapy protocols for advanced or recurrent disease.
• Melanoma: used in isolated limb perfusion or systemic regimens for metastatic lesions.

• Melphalan alkylates DNA by forming covalent cross‑links between guanine bases, which obstructs 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 commonly observed during treatment.
• Myelosuppression: neutropenia, anemia and thrombocytopenia may develop.
• Fatigue: persistent tiredness often reported by patients.
• Alopecia: reversible hair loss affecting scalp and body hair.
• Mucositis: inflammation of the oral and gastrointestinal mucosa.
• Diarrhea: loose stools may occur during therapy.

Serious or Rare Side Effects

• Secondary malignancies: risk of therapy‑related cancers such as leukemia.
• Severe infection: due to profound neutropenia and immune suppression.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis in rare cases.
• Renal toxicity: impaired kidney function may develop.
• Cardiac arrhythmia: occasional disturbances in heart rhythm.
• Anaphylactic reaction: rare but potentially life‑threatening hypersensitivity.

Prior to initiating melphalan therapy, several safety considerations should be addressed.

• Renal function: evaluate baseline creatinine and adjust dosing if necessary.
• Hematologic monitoring: perform regular complete blood counts to detect myelosuppression.
• Pregnancy: avoid use unless the potential benefit justifies the risk to the fetus.
• Concomitant myelosuppressive agents: use with caution due to additive bone‑marrow toxicity.
• Infection risk: monitor closely for signs of febrile neutropenia and initiate prompt antimicrobial therapy.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake the product.

Melphalan can interact with other medicines, influencing efficacy or safety.

Major Interactions (Avoid)

• Live vaccines: contraindicated because of immunosuppression.
• Strong CYP450 inducers (e.g., rifampin): may reduce melphalan exposure.
• Other alkylating agents: additive toxicity to bone marrow and mucosa.

Moderate Interactions (Monitor Closely)

• Antiemetics (e.g., ondansetron): may affect nausea control and QT interval.
• Nephrotoxic drugs (e.g., cisplatin): increase risk of renal impairment.
• Radiation therapy: combined use can enhance tissue damage and fibrosis.