Melphalan Aqvida (Melphalan)

Melphalan is an alkylating antineoplastic agent used in chemotherapy regimens for several cancer types.

• Multiple Myeloma: reduces malignant plasma‑cell proliferation, induces remission, and can extend progression‑free survival when used in appropriate dosing protocols.
• Ovarian Cancer: enhances the cytotoxic effect of platinum‑based regimens, contributing to tumor shrinkage and improved response rates in advanced disease.
• Melanoma: provides therapeutic benefit in advanced or metastatic melanoma, often as part of combination protocols to increase overall response.

• Melphalan exerts its antineoplastic activity by forming covalent cross‑links between DNA strands. These interstrand bonds impede DNA replication and transcription, leading to cell‑cycle arrest at the G2/M phase and triggering apoptosis in rapidly dividing tumor cells. The alkylating action preferentially affects malignant cells due to their higher proliferation rate, while normal tissues experience dose‑dependent toxicity.

Melphalan may cause a range of adverse reactions, varying from mild to severe, that require monitoring during therapy.

Common Side Effects

• Nausea and vomiting
• Fatigue or weakness
• Alopecia (hair loss)
• Mucositis (inflammation of the mouth lining)

Serious or Rare Side Effects

• Myelosuppression leading to severe neutropenia or anemia
• Renal toxicity manifested as increased serum creatinine
• Secondary malignancies such as therapy‑related leukemia

When using Melphalan, clinicians should observe several precautionary measures to minimize toxicity and ensure safe administration.

• Monitor blood counts: perform regular complete blood count assessments to detect myelosuppression.
• Assess renal function: evaluate serum creatinine and creatinine clearance before and during treatment.
• Evaluate hepatic function: check liver enzymes as melphalan is partially metabolized hepatically.
• Avoid use in patients with known hypersensitivity to alkylating agents.
• Use effective contraception: both male and female patients should employ reliable birth control during therapy and for a defined period after.
• Store at controlled room temperature: keep in original container, protect from light and moisture, and do not freeze.

Melphalan can interact with other medicines, altering its efficacy or increasing toxicity.

Major Interactions (Avoid)

• Concurrent use with other alkylating agents: may cause excessive bone‑marrow suppression.
• High‑dose radiation therapy: increases risk of severe tissue damage.
• Live vaccines: immunosuppression can lead to uncontrolled infection.

Moderate Interactions (Monitor Closely)

• CYP450 inducers (e.g., rifampin, phenobarbital): may reduce melphalan plasma levels.
• Nephrotoxic drugs (e.g., cisplatin, aminoglycosides): heighten risk of renal impairment.
• Anticoagulants (e.g., warfarin): may enhance bleeding tendency due to thrombocytopenia.