Melphalan Sun (Melphalan)

Melphalan is used as an antineoplastic agent targeting rapidly dividing cells in several solid‑tumor and hematologic malignancies.

• Multiple myeloma: reduces malignant plasma cell proliferation and improves survival outcomes.
• Ovarian cancer: contributes to tumor shrinkage when combined with platinum‑based regimens.
• Melanoma: used in high‑dose protocols for advanced disease to achieve disease control.
• Urothelial carcinoma: employed in systemic therapy for metastatic cases to extend progression‑free intervals.

• Melphalan exerts its cytotoxic effect by forming covalent cross‑links between DNA strands. The alkylating activity creates inter‑ and intra‑strand bonds that impede DNA replication and transcription, leading to cell cycle arrest and apoptosis in rapidly proliferating tumor cells. The resulting DNA damage triggers activation of p53‑dependent pathways and overwhelms repair mechanisms, further promoting programmed cell death.

Melphalan may cause a range of adverse reactions, varying in frequency and severity.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset occurring in many patients.
• Bone marrow suppression: decreased white blood cells, red cells and platelets.
• Fatigue: generalized tiredness affecting daily activities.
• Mucositis: inflammation of the mouth and gastrointestinal lining.
• Alopecia: temporary hair loss during treatment.

Serious or Rare Side Effects

• Secondary malignancies: risk of therapy‑related cancers such as leukemia.
• Severe infection: due to profound neutropenia.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis.
• Renal impairment: acute kidney injury in susceptible individuals.
• Cardiotoxicity: rare cardiac arrhythmias or myocardial injury.

Prior to initiating melphalan therapy, clinicians should evaluate patient-specific factors and follow safety guidelines.

• Baseline blood counts: obtain complete blood count to assess marrow reserve.
• Renal function: evaluate serum creatinine and adjust dosing if impairment is present.
• Hepatic status: monitor liver enzymes as hepatic dysfunction may increase toxicity.
• Pregnancy and lactation: avoid use in pregnant or breastfeeding women due to unknown fetal risk.
• Concomitant myelosuppressive agents: use caution when combined with other chemotherapy that depresses bone marrow.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze.

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

Major Interactions (Avoid)

• High‑dose cyclophosphamide: combined use markedly increases myelosuppression.
• Live vaccines: immunosuppression may lead to uncontrolled infection.
• Strong CYP inducers (e.g., rifampin): may reduce melphalan plasma levels.

Moderate Interactions (Monitor Closely)

• Antifungal azoles (e.g., fluconazole): can increase melphalan exposure.
• Allopurinol: may potentiate hematologic toxicity.
• NSAIDs: may exacerbate renal side effects.
• Granulocyte colony‑stimulating factor: may affect blood count recovery.