Melphalan Teva (Melphalan)

Melphalan is an alkylating antineoplastic agent used in the treatment of several solid tumours and hematologic malignancies.

• Multiple myeloma: induces remission, reduces tumor burden, and prolongs overall survival when used as part of combination chemotherapy protocols.
• Ovarian cancer: enhances response rates and may improve progression‑free survival when administered alongside platinum‑based chemotherapy in advanced disease.
• Melanoma: delivers cytotoxic activity against rapidly dividing melanoma cells, contributing to tumor shrinkage in metastatic or unresectable cases.
• Neuroblastoma: provides disease control and can be incorporated into high‑intensity regimens for high‑risk pediatric patients, supporting remission induction.

• Melphalan exerts its antineoplastic effect by alkylating nucleophilic sites on DNA, primarily the N7 position of guanine. This creates intra‑ and interstrand cross‑links that impede DNA replication and transcription, leading to cell cycle arrest and apoptosis in rapidly proliferating tumor cells. The drug is taken up by cells via passive diffusion and accumulates preferentially in malignant tissue. Its cytotoxic activity is dose‑dependent and contributes to the overall chemotherapy regimen.

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

Common Side Effects

• Nausea and vomiting: frequent gastrointestinal upset.
• Myelosuppression: lowered blood cell counts causing anemia, infection risk.
• Fatigue: persistent tiredness affecting daily activities.
• Mucositis: inflammation and ulceration of oral mucosa.
• Alopecia: reversible hair loss on scalp and body.
• Diarrhea: loose stools that may require hydration.

Serious or Rare Side Effects

• Secondary malignancies: risk of therapy‑related leukemia.
• Severe infections: opportunistic infections due to neutropenia.
• Pulmonary toxicity: interstitial pneumonitis or fibrosis.
• Renal impairment: possible acute kidney injury.

When using Melphalan, clinicians should observe several precautionary measures to minimise risks.

• Baseline assessment: obtain complete blood count and organ function tests before initiating therapy.
• Monitoring: perform regular CBC and renal/hepatic panels during treatment.
• Dose adjustments: modify dose in patients with impaired bone‑marrow reserve or renal dysfunction.
• Concomitant meds: avoid concurrent use of other myelosuppressive agents unless medically justified.
• Pregnancy and lactation: contraindicated; assess risk‑benefit and consider alternative therapy.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

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

Major Interactions (Avoid)

• Live vaccines: increased risk of infection due to immunosuppression.
• Strong CYP450 inducers: may reduce melphalan plasma levels (e.g., rifampin).
• High‑dose radiotherapy: additive bone‑marrow toxicity.
• Anticholinergic agents: may exacerbate urinary retention; avoid if possible.

Moderate Interactions (Monitor Closely)

• Anticoagulants: enhanced bleeding risk; monitor INR or aPTT.
• Nephrotoxic drugs: potential additive renal impairment (e.g., cisplatin).
• Allopurinol: may increase melphalan toxicity; adjust dose if necessary.
• Azathioprine: combined myelosuppression; monitor blood counts closely.