Alkeran-Melphalan

Patient Education Quick Reference Guide Diablo Valley Oncology/Hematology Medical Group Phone Number: 925-677-5041

WARNING Allergic reactions: Melphalan, when given into the vein (intravenous, IV), may cause allergic reactions during administration, including anaphylaxis (a severe, life threatening allergic reaction). Your doctor or healthcare provider will watch you carefully during and after the administration of melphalan to make sure that you do not experience any allergic reactions. If an allergic reaction occurs it is treatable with medications. Blood related problems: Melphalan may cause serious decreases in red blood cell, white blood cell and platelet levels which can cause anemia, infections, bruising and bleeding (see Precautions To Be Aware Of Before Taking This Medication). Secondary cancer: This medication may increase the risk of developing a cancer, including leukemia or carcinoma. Although it is not certain, it appears that this risk may be higher in patients who have received melphalan for long periods of time or who have received high total doses of melphalan.

Uses For This Medication

  • Melphalan is used to treat adults with multiple myeloma or ovarian cancer.
  • Melphalan may also be used alone or in combination with other chemotherapy medications for isolated limb perfusion for treatment of some cancers such as soft tissue sarcoma or melanoma.
  • Melphalan (in high doses) may also be used alone or in combination with other chemotherapy medications to prepare for a peripheral blood stem cell transplant after bone marrow ablation.
  • This medication may also be given for other conditions as determined by your doctor.
 

How This Medication Works

Melphalan is a chemotherapy medication that doesn’t allow cancer cells, also known as tumor cells, to divide and grow normally, which leads to tumor cell death.

Benefits of This Medication

Melphalan, alone or together with other chemotherapy medications, may slow down the growth of the tumor, or cancer. In patients who undergo peripheral blood stem cell transplant, melphalan alone or in combination with other chemotherapy medications are used to try to destroy any remaining cancer cells before receiving the new bone marrow/ stem cells. Who Should Not Take This Medication You should not take this medication if you:
  • Have taken melphalan before and had no response to it.
  • Are allergic to melphalan or any of its components.
  Precautions to be Aware of Before Taking This Medication

Blood related precautions

  • This medication may temporarily reduce the number of germ fighting white blood cells in your blood. This can increase your risk of infection. Contact your doctor or healthcare provider promptly if you develop any signs of an infection such as fever, painful urination, chills or a sore throat that doesn’t go away. If your white blood cell levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed and/or you receive medication to increase the number of white cells in your blood. To lower your risk of infection, stay away from crowds and people with colds or other illnesses, wash your hands well and often with soap and water, and brush and floss your teeth daily.
  • This medication may temporarily reduce the number of platelets in your blood. This can increase your risk of bleeding. Contact your doctor or healthcare provider if you notice unusual bleeding or bruising, have black or tar-like stools, see blood in your urine, or develop pinpoint red spots on your skin. If your platelet levels become too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a platelet transfusion, and/or that you take medication to help increase the number of platelets in your blood. To lower your chance of bleeding, do not use aspirin, aspirin-containing medications, or aspirin-like medications (for example ibuprofen, naproxen). Use caution with sharp objects like razors and nail cutters, and avoid activities that can cause cuts, bumps and bruises. Avoid flossing if you have been told your platelets are low.
  • This medication may temporarily lower the number of red cells in your blood. This can increase your risk of anemia. If your red blood cell level becomes low, you may feel tired and weak. If your red blood cell level becomes too low, your doctor or healthcare provider may recommend that your treatment be delayed, that you receive a red blood cell transfusion, and/or you receive a medication to help increase the red cells in your blood.
 

Organ related precautions

This medication can cause changes in the ability of your liver to work normally. Your doctor or healthcare provider will check your liver regularly, usually through blood tests, while you are on this medication to make sure that your liver is working properly. If you have any liver problems before starting this medication, make sure that you tell your doctor or healthcare provider so that he or she can watch you carefully for possible problems or side effects. This medication can suppress the ovaries in women. It can cause irregular menstrual periods or temporarily stop menstrual periods in women. It can also suppress the testicles in men.

Miscellaneous precautions

  • Do not receive any immunizations (vaccinations) while on this medication without your doctor or healthcare provider’s approval. This medication can increase your risk of infection. For certain immunizations, you may develop the infection that the immunization is intended to prevent.
 

Patient specific precautions

  • It is not known if this medication is safe and effective in children, but has been used to treat a number of childhood cancers
  Pregnancy and breastfeeding precautions This medication may cause fetal harm. When taking this medication, you should use effective birth control to prevent pregnancy. Tell your doctor or healthcare provider right away if you or your spouse/partner becomes pregnant. This medication may suppress ovarian function in premenopausal women, resulting in amenorrhea (menses stopping temporarily or permanently) in a significant number of patients. Reversible and irreversible (temporary and permanent) suppression of testicular function has also been reported. It is not known whether this medication is found or excreted in breast milk. Since many medications are excreted in breast milk and because this medication can cause serious harmful reactions in infants, breastfeeding should be avoided. Many anti-cancer therapies can cause sterility. Notify your doctor or healthcare provider if you want to have children in the future. Medication and Food Interactions Before using this medication, tell your doctor or healthcare provider of all prescription or over-the- counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies. Do not start or stop any medication without your doctor or healthcare provider’s approval.
  • Carmustine
  • Cimetidine
  • Cisplatin
  • Cyclosporine
  • Digoxin tablets
  • Nalidixic acid
NOTE: This list may not include all medications that can have interactions with melphalan. Side Effects
  • All medications can cause side effects. However, not all patients will experience these side effects. In addition, other side effects not listed can also occur in some patients. You should call your doctor or healthcare provider if you have any questions or concerns while you are on this medication.
  • You should contact your doctor or healthcare provider if you experience any side effect(s) which don’t go away, worsen, are serious in nature, or are worrisome to you.
  • Side effects can occur when melphalan is given alone or together with other chemotherapy medications. The side effects listed below are those reported in patients who were treated with melphalan alone.
 

More common side effects

  • Decreased platelet, red blood cell, and/or white blood cell levels (see Precautions To Be Aware Of Before Taking This Medication)
  • Nausea, vomiting, diarrhea, sores on the mouth or on the lips
 

Rare side effects

This is not a complete list of the rare side effects reported with melphalan. For a complete list, please talk with your doctor or healthcare provider about reviewing a copy of the package insert.
  • Liver problems (see Precautions To Be Aware Of Before Taking This Medication)
  • Scarring of the lungs
  • Rash
  • Hair loss
  • Allergic reactions (see Precautions To Be Aware Of Before Taking This Medication)
  • Skin reaction at the injection site
  • Hemolytic anemia- a serious, and sometimes fatal, blood condition in which your body makes antibodies that destroy your own red blood cells. This results in a very low red blood cell level
  • Development of another cancer (see Warning)
  How To Take This Medication
  • This medication is either taken by mouth (orally) or given by injection into a vein (IV) by a healthcare professional. This medication can be given in different doses depending on your weight, whether you are receiving IV or oral melphalan, your type of condition, and whether melphalan is being given with other chemotherapy medications. If you are taking this medication orally, be sure to take it exactly as directed by your doctor or healthcare provider. If you do not understand these instructions, ask your doctor or healthcare provider to explain them to you.
  • Antiemetics, which are medications to help prevent and control nausea and vomiting, may be given before melphalan either by mouth (orally) or by injection into a vein (IV).
  • In the unlikely event of an overdose of this medication contact your doctor, your local poison control center at 1-800-222-1222, or emergency services immediately.
  Proper Storage
  • If you are receiving the IV form of melphalan, it is unlikely that you will need to store this medication. However, in the event that you do, the unopened containers should be stored at controlled room temperature and protected from light.
  • If you are taking the oral form of melphalan, the tablets should be stored in the refrigerator and protected from light.
  • Keep this medication out of the reach of children or pets.
  • Ask your doctor or healthcare provider how to dispose of any medication that you no longer use.