Melphalan
Melphalan hydrochloride (trade name Alkeran) is a chemotherapy drug belonging to the class of nitrogen mustard alkylating agents.
An alkylating agent adds an alkyl group (CnH2n+1) to DNA. It attaches the alkyl group to the guanine base of DNA, at the number 7 nitrogen atom of the imidazole ring.
Otherwise known as L-Phenylalanine Mustard, or L-PAM, melphalan is a phenylalanine derivative of mechlorethamine.
Uses
It is used to treat multiple myeloma[1] and ovarian cancer, and occasionally malignant melanoma.
The agent was first investigated as a possible drug for use in melanoma. It was not found to be effective, but has been found to be effective in the treatment of myeloma.
Administration
Oral or intravenous; dosing varies by purpose and route of administration as well as patient weight.
Side effects
Common side effects include:
* Nausea and vomiting, and oral ulceration.
* Bone marrow suppression, including
o Decreased white blood cell count causing increased risk of infection
o Decreased platelet count causing increased risk of bleeding
Less common side effects include:
* Severe allergic reactions
* Pulmonary fibrosis (scarring of lung tissue) including fatal outcomes (usually only with prolonged use)
* Hair loss
* Interstitial pneumonitis
* Rash
* Itching
* Irreversible bone marrow failure due to melphalan not being withdrawn early enough.
* Cardiac arrest.
References
1. ^ Facon T, Mary JY, Hulin C, et al. (October 2007). “Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial”. Lancet 370 (9594): 1209–18. doi:10.1016/S0140-6736(07)61537-2. PMID 17920916. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(07)61537-2.