Melphalan Macure (Melphalan)

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

• Multiple myeloma: reduces malignant plasma‑cell burden and prolongs survival.
• Ovarian cancer: enhances cytotoxic response when combined with platinum‑based regimens.
• Melanoma: provides tumor‑cell DNA cross‑linking to limit disease progression.
• High‑dose chemotherapy for solid tumours: serves as a conditioning agent before stem‑cell transplantation.

• Melphalan alkylates the N7 position of guanine bases in DNA, creating intra‑ and interstrand cross‑links that block DNA replication and transcription. The resulting DNA damage triggers cell‑cycle arrest and apoptosis, preferentially affecting rapidly dividing malignant 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 common during infusion.
• Myelosuppression: decreased white blood cells, red cells and platelets.
• Mucositis: inflammation of the oral and gastrointestinal mucosa.
• Fatigue: generalized tiredness during treatment cycles.
• Alopecia: reversible hair loss.
• Electrolyte disturbances: especially low potassium or magnesium.

Serious or Rare Side Effects

• Secondary malignancies: risk of therapy‑related leukemia.
• Severe infection: due to profound neutropenia.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis.
• Cardiotoxicity: rare arrhythmias or myocardial injury.
• Renal impairment: acute kidney injury in high‑dose settings.
• Hypersensitivity reactions: anaphylaxis or severe skin rash.

Before using Melphalan, clinicians should consider several safety measures.

• Baseline blood counts: obtain complete blood count to assess marrow reserve.
• Renal function: evaluate serum creatinine and adjust dose if needed.
• Hepatic function: monitor liver enzymes for potential toxicity.
• Pregnancy: avoid use; melphalan is contraindicated in pregnancy (Category D).
• Contraception: advise both male and female patients to use effective contraception during treatment and for a defined period afterward.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Live vaccines: risk of severe infection due to immunosuppression.
• High‑dose methotrexate: additive myelosuppression.
• CYP450 inducers (e.g., rifampin): may reduce melphalan exposure.

Moderate Interactions (Monitor Closely)

• Antiemetics (e.g., ondansetron): may affect melphalan metabolism.
• ACE inhibitors: potential for enhanced nephrotoxicity.
• Anticoagulants: increased bleeding risk due to thrombocytopenia.