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Generic name: Melphalan

Alkeran is the trade name for Melphalan. L-PAM, L-Sarcolysin, and Phenylalanine Mustard are other names for Melphalan. In some cases, health care professionals may use the trade name Alkeran or other names L-PAM, L-Sarcolysin, and Phenylalanine Mustard when referring to the generic drug name Melphalan.

Drug type:
Alkeran is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. Alkeran is classified as an "alkylating agent." (For more detail, see "How this drug works" section below).

What this drug is used for:
- Multiple myeloma
- Ovarian cancer
- Neuroblastoma
- Rhabdomyosarcoma
- Breast cancer
- Used in some conditioning regimens prior to bone marrow transplant
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How this drug is given:
- As a pill by mouth. Tablets come in a 2mg size.
- Take medication on an empty stomach (1 hour before to 2 hours after meals).
- As an injection or infusion into the vein (intravenous, IV).
- The amount of melphalan that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.

Side effects:
Important things to remember about the side effects of melphalan:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
- The side effects of melphalan and their severity depend on how much of the drug is given. In other words, high doses may produce more severe side effects).

The following side effects are common (occurring in greater than 30%) for patients taking melphalan:
- Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding. This effect may be prolonged and cumulative.
- Nausea and vomiting. (mild with regular dosing, can be severe with high-dose therapy)

These side effects are less common side effects (occurring in about 10-29%) of patients receiving melphalan:
- Allergic reaction. (rare with pill form, happen in about 10% of patients treated with IV form).
- Mouth sores. (mild with regular dosing, can be severe with high-dose therapy).
- Diarrhea. (mild with regular dosing, can be severe with high-dose therapy).
- Loss of fertility. Meaning, your ability to conceive or father a child may be affected by melphalan. Discuss this issue with your health care provider.
- Hair loss. (rare with regular dosing, common with high-dose used for bone marrow transplant).
- Nephrotoxicity (see kidney problems): Uncommon with regular doses, seen when melphalan is given in high-doses used for bone marrow transplant.
- Arrythmias (see heart problems): Uncommon with regular doses, seen when melphalan is given in high-doses used for bone marrow transplant.

Delayed effects:
There is a slight risk of developing a blood cancer such as leukemia or myelodysplasia after taking melphalan. Talk to your doctor about this risk.
Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 7 days
Nadir: 8-10 days (white blood cells), 27-32 days (platelets).
Recovery: 42-50 days

Precautions:
- Before starting melphalan treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
- Do not receive any kind of immunization or vaccination without your doctor's approval while taking melphalan.
- Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (melphalan may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking melphalan. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.

Self-care tips:
- If taking melphalan pills take on an empty stomach 1 hour before or 2 hours after meals.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- This medication when taken as pills causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and testing:
You will be checked regularly by your health care professional while you are taking melphalan, to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.

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