Question 1

What is Melphalan used for?

Accepted Answer

Melphalan is an alkylating agent used in the treatment of multiple myeloma, ovarian cancer, and as high-dose conditioning therapy prior to autologous or allogeneic hematopoietic stem cell transplantation (HSCT). Hepzato (melphalan) is also used for hepatic delivery in uveal melanoma with liver metastases.

Question 2

How does Melphalan work?

Accepted Answer

Bifunctional alkylating agent (nitrogen mustard derivative). Cross-links DNA strands by alkylating guanine residues, preventing DNA replication and transcription. Cell cycle non-specific. Active against both dividing and non-dividing cells. Cytotoxic effect leads to apoptosis in susceptible tumor cells.

Question 3

What are the common side effects of Melphalan?

Accepted Answer

Myelosuppression (leukopenia, thrombocytopenia, anemia) -- dose-limiting toxicityNausea and vomiting (more pronounced with high-dose IV)Oral mucositis (particularly with high-dose conditioning)AlopeciaDiarrheaFatigueAmenorrhea, infertility

Question 4

What are the serious side effects of Melphalan?

Accepted Answer

Severe neutropenia with febrile neutropenia risk; nadir typically 14-21 days after treatmentSevere thrombocytopenia with bleeding riskGrade 3-4 mucositis (common with high-dose conditioning; may require parenteral nutrition and IV opioids)Pulmonary fibrosis (rare, cumulative)Secondary malignancies (AML/MDS, long-term risk)Severe nausea/vomiting requiring aggressive antiemetic managementHepatic veno-occlusive disease (sinusoidal obstruction syndrome) in transplant setting

Question 5

What are the warning signs or red flags when taking Melphalan?

Accepted Answer

Febrile neutropenia (ANC <500 cells/mcL with fever >=38 C) -- initiate empiric antibiotics per protocolPlatelet count <10,000/mcL or active bleedingGrade 3-4 mucositis impeding oral intake or airwaySigns/symptoms of pulmonary toxicity (dyspnea, new infiltrates)Hemodynamic instability or severe infectionAnaphylaxis/hypersensitivity reaction during IV infusion

Question 6

How is Melphalan dosed and administered?

Accepted Answer

Oral (palliative, multiple myeloma): typically 0.15-0.25 mg/kg/day PO x 4-7 days every 4-6 weeks, often combined with prednisone or in MPT/MPV regimens. High-dose (HSCT conditioning, Evomela): 100-200 mg/m2 IV, administered 1-2 days prior to stem cell infusion. Verify dose and regimen against current institutional protocol and prescribing information. Dose reductions required for renal impairment., given intravenously (IV).

Question 7

What drug interactions does Melphalan have?

Accepted Answer

Cyclosporine: increased risk of nephrotoxicity when used concurrently -- monitor renal function closely. Nalidixic acid: may potentiate toxicity (avoid concurrent use). Carmustine and other alkylating agents: additive myelosuppression. Interferon alfa: may reduce melphalan AUC. Live vaccines: contraindicated during immunosuppressive therapy. Verify all concurrent medications for potential interactions via current drug interaction database.

Question 8

What should be monitored while taking Melphalan?

Accepted Answer

Baseline and prior to each cycle: CBC with differential, CMP (renal and hepatic function). Nadir CBC expected 14-21 days post-treatment (may be delayed with prior therapy or renal impairment). In HSCT setting: daily CBC during engraftment period, electrolytes, LFTs, urinalysis as ordered. Engraftment typically defined as ANC >=500 x 3 days. Document and trend all values. Monitor vital signs pre-, during, and post-IV infusion per institutional policy. In transplant setting: monitor daily weights, temperature (report fever >=38 C per protocol),...

Question 9

Are there any contraindications for Melphalan?

Accepted Answer

Contraindicated in patients with known hypersensitivity to melphalan or chlorambucil (cross-reactivity possible). Teratogenic and embryotoxic -- contraindicated in pregnancy (Category D); ensure negative pregnancy test prior to initiation. Avoid in breastfeeding. Dose reduction required with renal impairment (GFR <50 mL/min for oral; consult prescribing information for IV). Use with caution in hepatic impairment. Verify prior to each cycle.

Question 10

When should I seek urgent care while taking Melphalan?

Accepted Answer

Instruct patient to go to the nearest emergency department or call 911 for: fever >=100.4 F (38 C), uncontrolled bleeding, inability to take oral medications, signs of severe infection, chest pain, or shortness of breath. Advise patient to call the oncology clinic before going to the ER when clinically feasible. Provide after-hours emergency contact information at each visit.

Question 11

What should I do if I miss a dose of Melphalan?

Accepted Answer

Oral melphalan: if a dose is missed and it is within a few hours, it may be taken as soon as remembered unless near the time of the next dose. Do not double-dose. Advise patient to contact their oncology provider for specific guidance. Document any missed doses in the medication administration record.

Question 12

How should Melphalan be stored?

Accepted Answer

Melphalan is a hazardous drug (NIOSH Table 1). Handle per USP 800 standards: use appropriate PPE (gloves, gown, eye protection) during preparation, administration, and disposal. IV preparation must be performed in a certified pharmacy biosafety cabinet. Educate patient and caregivers on safe handling of oral tablets (gloves for caregivers) and body fluid precautions for 48 hours post-treatment.

Melphalan (Nurse)

Melphalan (Nurse)

Drug Name

Purpose / Indication

Dose Schedule

Route

Timing Considerations

Food Relation

Time of Day

Special Instructions

Injection Techniques

Mechanism

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Melphalan (Nurse)

Drug Name

Purpose / Indication

Dose Schedule

Route

Timing Considerations

Food Relation

Time of Day

Special Instructions

Injection Techniques

Mechanism

12 More Sections — Members Only

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Melphalan (Patient)

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