Melphalan adverse effects

Generic Name Melphalan Trade Name Alkeran Primary Antineoplastic Indication(s) Ovarian carcinoma multiple myeloma Common Adverse Effects Blood disorders [leukopenia, thrombocytopenia] skin rashes/itching... 

The adverse effects of high-dose intravenous melphalan have been reviewed (2). Two patients who received less than 100 mg/m recovered from marrow aplasia within 3 weeks without major complications. A third patient died 6 days after injection of 290 mg/m, probably because of a cardiac dysrhythmia before complete marrow failure had become established. After intravenous administration of more than 125 mg/m, gastrointestinal adverse effects, such as hemorrhagic diarrhea, or bowel perforation, can occur. These, together with reduced ADH secretion and electrolyte disturbances are the predominant clinical problems and the reasons for early death before the occurrence of infectious or bleeding complications from prolonged marrow aplasia. 

In 10 myeloma patients the AUC of melphalan 250 microgram/kg was re-dueed by 13% when it was given 5 hours after the administration of human interferon alfa (7 x 10 units/m ), possibly due to the fever caused by the interferon. The elinieal importance of this is uncertain but the authors of the report suggest that despite this small reduction in the AUC, the cytotoxicity of the melphalan is increased by the fever. The use of interferon alfa with melphalan and prednisone in multiple myeloma has been associated with more adverse effects. 

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