Melphalan

Definition
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Cytostatic agent.

Half-life
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1,5–2 h

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Indication
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Plasmocytoma, ovarian and breast carcinoma, for regional extremity perfusion in metastatic malignant melanoma.

Limited indication
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Myelosuppression, reduced general condition, acute infections. Melphalan has already been tested in studies for the treatment of nephrogenic systemic fibrosis, but without convincing results.

Pregnancy/nursing period
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Contraindicated during pregnancy (mutagenic effect!). Do not breastfeed if treated during the breastfeeding period!

Dosage and method of use
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0.15-0.2 mg/kg bw/day p.o. over 4-5 days every 4 weeks or 8-30 mg/m2 KO every 2-6 weeks i.v. For limb perfusion (high-dose therapy) 100-200 mg/m2 KO once

Undesirable effects
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See Table 1.

Interactions
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Decrease of the Ciclosporin A level, phenylbutazone increases the melphalan toxicity.

Contraindication
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Vaccination with live vaccines

Preparations
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Alkerane

Note(s)
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Remember! Contraception: Women during treatment, men during treatment and 6 months afterwards!

Remember! During therapy, regular blood count checks!

Literature
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Garrido-Laguna I et al (2007) Is there any reason to delay introduction of tumor necrosis factor in the management of in-transit metastasis of unresectable melanoma? J Clin Oncol 25: 1149
Jaccard A (2007) et al High-dose melphalan versus melphalan plus dexamethasone for AL amyloidosis. N Engl J Med 2007 357: 1083-1093

Tables
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Side effects of Melphalan

General symptoms	Fever
Airways	Pulmonary fibrosis (reversible, GD > 2,000 mg) interstitial pneumonia
Blood, lymph	Disorders of hematopoiesis Immunosuppression secondary leukemias (after long-term therapy)
Electrolytes, metabolism, endocrinium	disorders of spermatogenesis and ovulation
GIT	gastrointestinal disorders (nausea, vomiting, diarrhoea) Hepatotoxicity, icterus
Urinary tract	secondary hyperuricemia, cystitis
skin/mucosa	hair loss, allergic/toxic reactions (up to Stevens-Johnson syndrome and toxic epidermal necrolysis), dermatitis, stomatitis
Nervous System	Seizures in children, peripheral neuropathy
Sensory Organs	Optic atrophy, reduction of visual acuity