melphalan hydrochloride at a glance
Medicine class
Cytotoxic alkylating agent and nitrogen mustard analogue.
Key monitoring
Regular blood counts are essential because bone-marrow suppression may continue to worsen after treatment.
What is melphalan hydrochloride used for?
The selected UK injectable product is licensed for:
Multiple myeloma, including intensive treatment with or without haematopoietic stem-cell transplantation.
Advanced ovarian cancer.
Childhood neuroblastoma as intensive treatment with haematopoietic stem-cell support.
Localised malignant melanoma affecting a limb, using regional arterial perfusion.
Localised soft-tissue sarcoma affecting a limb, using regional arterial perfusion.
How does melphalan hydrochloride work?
Melphalan forms covalent bonds with guanine in DNA and cross-links the two DNA strands. This obstructs DNA replication, reducing the ability of rapidly dividing cancer cells to survive and multiply.
melphalan hydrochloride preparations and strengths
Injection
Route: Parenteral
Strengths: 50 mg
How to take melphalan hydrochloride
This formulation is prepared and administered by trained healthcare professionals. It is given into a vein or, for certain localised limb tumours, into the artery supplying the affected area. Intensive intravenous treatment requires specialist facilities and may be given through a central venous line. Report pain, burning or swelling around the administration site immediately.
Do not handle or prepare the product yourself.
The reconstituted solution must be prepared shortly before use and must not be refrigerated.
Only compatible infusion fluid specified in the product information should be used by the preparing team.
melphalan hydrochloride side effects
Common or expected effects
- Reduced white cells, red cells and platelets, increasing the risks of infection, tiredness, bruising and bleeding.
- Nausea, vomiting or diarrhoea, particularly with intensive treatment.
- Mouth inflammation or ulcers.
- Hair loss.
- Warmth or tingling at the injection site.
- Muscle problems when administered by regional limb perfusion.
Get urgent medical advice
- Severe infection or profound bone-marrow suppression.
- Serious allergic reaction, including swelling, wheezing or collapse.
- Tissue injury if the solution leaks outside the blood vessel.
- Blood clots, particularly with certain combination treatments.
- Severe lung inflammation or fibrosis.
- Liver injury, jaundice or hepatic veno-occlusive disease.
- Severe muscle injury after regional limb perfusion, sometimes with dark urine.
- Secondary myelodysplastic syndrome or acute myeloid leukaemia.
melphalan hydrochloride in pregnancy
Melphalan can damage genetic material, and human pregnancy data are limited. It should generally be avoided during pregnancy unless specialist assessment concludes that treatment is clinically necessary. Effective contraception is required for patients who could conceive or father a child, and fertility preservation should be discussed before treatment where appropriate.
melphalan hydrochloride while breastfeeding
Breastfeeding is contraindicated during treatment because it is unknown whether melphalan enters breast milk and its mutagenic effects could pose a serious risk to the infant. Discuss feeding options with the specialist team.
melphalan hydrochloride interactions
The cancer team should review all prescribed, non-prescribed and complementary products before treatment.
Live vaccines
Avoid during clinically significant immunosuppression because the vaccine organism may cause infection; vaccination plans should be agreed with the specialist team.
Nalidixic acid
Avoid combination with intensive intravenous melphalan because fatal haemorrhagic enterocolitis has been reported in children.
Busulfan
In paediatric conditioning regimens, the sequence and timing may affect toxicity and must be managed by the transplant team.
Common questions about melphalan hydrochloride
Answers are fully visible for fast scanning and source review.
Is melphalan hydrochloride chemotherapy?
Yes. It is cytotoxic chemotherapy from the alkylating-agent class and damages DNA in susceptible cells.
Which cancers can melphalan hydrochloride injection treat?
Its UK-licensed uses include multiple myeloma, advanced ovarian cancer, childhood neuroblastoma and selected localised melanoma or soft-tissue sarcoma of a limb.
Why is melphalan hydrochloride used before a stem-cell transplant?
Intensive melphalan can suppress or destroy malignant and bone-marrow cells; transplanted stem cells then help restore blood-cell production.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.