Melphalan Accord-Uk (Melphalan)

• Melphalan is an alkylating antineoplastic used in several solid‑tumour and hematologic malignancies.
• Multiple myeloma: contributes to disease control and prolongs survival when combined with other chemotherapy agents.
• Ovarian cancer: used as part of high‑dose regimens to improve response rates.
• Melanoma: administered in metastatic settings to achieve tumor reduction.
• Neuroblastoma: incorporated into intensive protocols for high‑risk pediatric patients.

• Melphalan exerts its antineoplastic effect by forming covalent cross‑links between DNA strands. These cross‑links inhibit DNA replication and transcription, ultimately triggering apoptosis in rapidly dividing cancer cells. The drug preferentially targets proliferating cells due to their limited capacity for DNA repair, leading to selective tumor cytotoxicity.

Melphalan may cause a range of adverse reactions, from mild to life‑threatening.

Common Side Effects

• Nausea and vomiting: frequent gastrointestinal upset during and after infusion.
• Myelosuppression: reduced white blood cells, platelets, and red cells.
• Alopecia: temporary hair loss during treatment cycles.
• Fatigue: persistent tiredness affecting daily activities.

Serious or Rare Side Effects

• Secondary malignancies: risk of developing new cancers after prolonged exposure.
• Pulmonary fibrosis: scarring of lung tissue leading to breathing difficulties.
• Severe infection: opportunistic infections due to immune suppression.
• Hemorrhagic cystitis: bladder inflammation with bleeding.
• Renal toxicity: impaired kidney function in susceptible patients.
• Cardiac arrhythmia: irregular heart rhythms in high‑dose settings.

• Use of Melphalan requires careful monitoring and specific safety measures.
• Monitor blood counts: perform regular CBCs to detect myelosuppression early.
• Assess renal function: evaluate creatinine clearance before each dose.
• Avoid in pregnancy: drug is contraindicated due to teratogenic risk (Category D).
• Use protective handling: wear gloves and avoid aerosol generation during preparation.
• Adjust for hepatic impairment: consider dose reduction in patients with liver dysfunction.
• Store at controlled room temperature: keep in original container, protect from light and moisture.

Melphalan can interact with several drug classes, influencing safety and efficacy.

Major Interactions (Avoid)

• Live vaccines: contraindicated because of immunosuppression.
• Myelotoxic agents: concurrent use heightens bone‑marrow suppression.
• Nephrotoxic drugs: combined exposure increases risk of renal injury.

Moderate Interactions (Monitor Closely)

• Antiemetics (e.g., ondansetron): may alter melphalan clearance.
• Anticoagulants (e.g., warfarin): increased bleeding tendency.
• Azole antifungals (e.g., fluconazole): potential effect on drug metabolism.