Alkeran

Melphalan (alkeran) instructions

Common name: melphalan

Trade name: alkeran

All names: melphalan, melphalan, melphalan, L-phenylalanine mustard, Alkeran, Melphalan

Indications:

This product can be used for a variety of tumors. It is the drug of choice for multiple myeloma in single chemotherapy and combination chemotherapy. It is effective for seminoma, breast cancer, ovarian cancer, chronic leukemia, polycythemia vera, malignant lymphoma, late childhood neuroblastoma, and thyroid cancer. Arterial infusion has good efficacy in the treatment of malignant tumors of the limbs, such as malignant melanoma, soft tissue sarcoma and osteosarcoma. It is occasionally used to treat certain autoimmune diseases and prevent rejection reactions during organ transplantation.

Usage and dosage:

Because Melphalan has a bone marrow suppression effect, it is necessary to frequently monitor the blood picture (blood cell count) during the treatment period, and suspend the medication or adjust the dose if necessary. Or as directed by your doctor.

Recommended dosage:

Oral Administration in Adults: Absorption of oral melphalan is variable to ensure that possible therapeutic levels are achieved. The dose should be increased cautiously until myelosuppression occurs.

Multiple myeloma: There are many treatment options, and the literature should be reviewed in detail. The combination of melphalan and prednisone may be more effective than melphalan alone. The combination is usually administered intermittently. Although the superiority of extended dosing has not been proven, a typical dose is 0.15 mg/kg body weight daily in divided doses for four days, with the course repeated after six weeks. Extending treatment beyond one year in responders will not improve outcomes.

Ovarian adenocarcinoma: The typical treatment regimen is 0.2 mg per kilogram of body weight daily for five days, with repeated treatment every 4 to 8 weeks or when the peripheral blood picture recovers; the dose should be reduced when bone marrow toxicity occurs.

Advanced breast cancer: Oral melphalan is administered at 0.15 mg per kilogram of body weight or 6 mg per square meter of body surface area daily for 5 days. The course of treatment is repeated every six weeks. Intravenous melphalan can also be used for treatment.

Polycythemia vera: During the induction remission period, use 6 to 10 mg daily for 5 to 7 days, and then 2 to 4 mg daily until symptoms can be satisfactorily controlled. The maintenance dose can be 2 to 6 mg once a week. During this period, the patient must be carefully controlled by hematology, and the dose should be adjusted appropriately based on the blood cell count results.

Patients with renal insufficiency: Based on the currently established pharmacokinetic data, it is not absolutely recommended to reduce the dose of oral melphalan in patients with moderate to severe renal insufficiency, but the initial dose needs to be lowered with caution.

Adverse reactions:

The most common adverse reaction of melphalan is bone marrow suppression, which can lead to leukopenia and thrombocytopenia. Up to 30% of patients experience gastrointestinal discomfort, including nausea and vomiting, after oral administration of conventional doses of melphalan. Gastritis is rare with conventional doses of melphalan, but high-dose intravenous melphalan may increase the likelihood of diarrhea, vomiting, and gastritis. Pretreatment with cyclophosphamide has been reported to reduce melphalan-induced gastrointestinal injury. Occasionally, patients who received treatment for more than several months developed allergic reactions to melphalan, such as urticaria, edema, rash, and anaphylactic shock. Another two cases experienced cardiac arrest. However, whether this side effect was caused by melphalan has not yet been confirmed. Maculopapular rash and itching have also been occasionally reported. There have been cases showing that pulmonary fibrosis and hemorrhagic anemia occurred after the use of melphalan. Hair loss has been reported, but it is not common.

Contraindications:

It is contraindicated for women with a history of allergy to this product and pregnant and lactating women. It is not suitable for those who have recently undergone chemotherapy or radiotherapy and have leukopenia.

Notes:

1. Use with caution in patients with poor renal function.

2. Because this product can increase blood urea nitrogen, the blood picture and blood urea nitrogen level should be monitored during use. The drug should be discontinued when the neutrophil count falls below 2×109/L.

3. (1) The blood image must be checked before each medication. The medication should be stopped when the neutrophil count is lower than 2×109/L.

(2) The dose should be adjusted according to the degree of bone marrow suppression.

(3) If you are allergic to this drug, please do not take it Avoid drinking alcohol, taking Aspirin (Tapal) or cold medicine, and inform your doctor;

(4) Before receiving vaccination, you need to inform your doctor. You are prone to infection, and you need to avoid going to public places and prevent colds. Do not breastfeed or become pregnant. Taking this medicine may cause infertility;

4. Pregnant women who use melphalan medicine incorrectly can cause Fetal malformations

Melphalan drugs can enter the fetus from the blood of pregnant women through the placenta and directly cause toxic effects on the fetus. Especially in the first three months of pregnancy, because the fertilized egg is in the differentiation stage and various systems have not yet been formed and are in the development stage, the embryonic cells are affected by chemical drugs, which may induce mutations in genetic material, leading to fetal malformations.

Using melphalan in the early stages of pregnancy can cause fetal limb malformations and congenital abnormalities. Use after 4 months of pregnancy can cause fetal bone and tooth development disorders; other drugs such as: kanamycin, gentamicin, and streptomycin can damage the fetal auditory nerve, causing congenital abnormalities; antipyretic and analgesic drugs such as aspirin and aminopyrine can cause fetal central nervous system and kidney malformations; large doses of corticosteroids (prednisone) can prevent multiple fetal malformations, such as cleft lip and cleft palate. Sex hormones can cause endocrine changes in the fetus. For example, testosterone propionate can masculinize the external genitalia of female fetuses; sedatives (Hibernex, perphenazine, etc.), anti-drugs (chlorpheniramine, diphenhydramine, etc.), diuretics (hydrochlorothiazide, etc.), and long-term use of nasal drops can cause developmental disorders of the fetal nervous system and have other potential teratogenic effects. In addition, medicines that break Qi and promote blood circulation, severe cold, severe heat, and slippery sedimentation can have adverse effects on both the mother and the fetus. Melphalan medicines should be used with caution.

Storage:

Tablets: Keep dry below 2-8 degrees. Injections: Store away from light and below 30 degrees. Melphalan is used as a reference for various chemotherapy regimens for multiple myeloma. The use of each regimen needs to be used under the guidance of a doctor depending on the patient's condition. The adult body surface area is generally about 1.5m2 and the MP regimen is the only oral regimen among the melphalan regimens. Its advantage is that it is easy to treat at home.