Melphalan Sun (Melphalan)

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

• Multiple Myeloma: reduces malignant plasma cell proliferation and improves survival outcomes.
• Ovarian Cancer: enhances cytotoxic effect when combined with platinum‑based regimens.
• Melanoma: provides DNA cross‑linking to inhibit tumor growth in advanced disease.

• Melphalan exerts its antineoplastic activity by forming covalent cross‑links between DNA strands. It alkylates the N7 position of guanine bases, preventing DNA replication and transcription. The resulting DNA damage triggers cell‑cycle arrest and apoptosis, preferentially affecting rapidly dividing tumor cells while sparing most normal tissues at therapeutic concentrations. The drug is administered as a pro‑drug that is hydrolyzed intracellularly to the active alkylating species, and its efficacy is influenced by cellular glutathione levels.

Melphalan may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset that may require anti‑emetic therapy.
• Fatigue: persistent tiredness affecting daily activities during treatment cycles.
• Decreased white blood cell count (neutropenia): lowered immunity increasing infection risk.

Serious or Rare Side Effects

• Severe bone marrow suppression (anemia, thrombocytopenia): can cause bleeding, fatigue, and may need transfusion.
• Secondary malignancies (e.g., acute leukemia): rare risk of developing new cancers after prolonged exposure.
• Pulmonary toxicity (interstitial pneumonitis): inflammation of lung tissue that may present with cough and dyspnea.

Before initiating therapy, clinicians should observe several safety measures.

• Monitor blood counts: perform regular complete blood count tests to detect neutropenia or anemia.
• Assess renal function: evaluate creatinine clearance before each dose and adjust if impaired.
• Evaluate hepatic function: check liver enzymes as melphalan is metabolized hepatically.
• Avoid use in active infection: postpone treatment if patient has uncontrolled bacterial or viral infection.
• Use effective contraception: both male and female patients should employ reliable birth control during therapy and for several months after.
• Store at controlled room temperature: keep in original packaging, protect from light and moisture.

Melphalan can interact with several medicines; some combinations should be avoided while others require careful monitoring.

Major Interactions (Avoid)

• Concurrent use with other alkylating agents: additive bone marrow toxicity.
• High‑dose radiation therapy: increased risk of severe tissue damage.
• Live vaccines: compromised immune response may lead to infection.

Moderate Interactions (Monitor Closely)

• CYP450 inducers (e.g., rifampin): may reduce melphalan plasma levels.
• Nephrotoxic drugs (e.g., cisplatin): combined renal toxicity risk.
• Anticoagulants (e.g., warfarin): potential for enhanced bleeding due to thrombocytopenia.
• Immunosuppressants (e.g., cyclosporine): may increase infection susceptibility.