Melphalan Macure (Melphalan)

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

• Multiple myeloma: helps achieve disease control and prolong survival.
• Ovarian cancer: used as part of combination regimens to reduce tumour burden.
• Melanoma: administered to slow progression in advanced stages.
• Other solid tumours: incorporated into protocols for selected refractory cancers.

• Melphalan exerts its antineoplastic effect by alkylating DNA bases, creating cross‑links that block 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 can cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset commonly reported during treatment.
• Myelosuppression: reduced white blood cells, platelets and red cells.
• Alopecia: hair loss that may be temporary.
• Fatigue: persistent tiredness affecting daily activities.

Serious or Rare Side Effects

• Secondary malignancies: risk of developing new cancers after prolonged exposure.
• Severe infection: due to profound neutropenia.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis.
• Renal or cardiac toxicity: impaired kidney function or cardiac complications.

Melphalan requires careful monitoring and specific safety measures before and during therapy.

• Blood count monitoring: perform complete blood counts regularly to detect myelosuppression.
• Renal function assessment: evaluate serum creatinine and adjust dosing if needed.
• Hepatic function evaluation: check liver enzymes prior to each cycle.
• Pregnancy risk: avoid use in pregnant women unless benefits outweigh potential fetal harm.
• Handling precautions: use protective equipment and follow hazardous drug guidelines.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

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

Major Interactions (Avoid)

• Concurrent alkylating agents: additive bone‑marrow toxicity.
• High‑dose radiation therapy: increased risk of severe tissue damage.
• Live vaccines: potential for uncontrolled infection due to immunosuppression.
• Nephrotoxic antibiotics (e.g., aminoglycosides): heightened renal toxicity.
• Drugs that impair bone‑marrow function (e.g., antimetabolites): profound cytopenias.

Moderate Interactions (Monitor Closely)

• Azole antifungals: may increase melphalan plasma levels.
• Allopurinol: can enhance myelosuppressive effects.
• ACE inhibitors or ARBs: monitor renal parameters.
• NSAIDs: watch for additive gastrointestinal irritation.
• Diuretics: assess electrolyte balance and renal function.