- Melphalan must be administered in carefully adjusted doses under the supervision of a physician experienced in cancer chemotherapy
- Nitrogen mustard therapy may be associated with an increased incidence of secondary malignant tumors
- Therapy with nitrogen mustards may produce marked bone marrow depression. Observe patients closely for signs of myelosuppression such as severe infections, bleeding, and symptomatic anemia
- Monitor CBC, platelet count, WBC with differential count at baseline and prior to each course of therapy. Frequent monitoring is necessary for accurate dosage adjustments and prevention of toxicity
- Carefully weigh anticipated benefits with expected risks. Use with extreme caution in patients whose bone marrow reserve may have been compromised by prior irradiation or chemotherapy
- Pulmonary toxicity characterized by pulmonary infiltrates and/or fibrosis, interstitial pneumonitis have been reported in patients receiving melphalan
- Reversible hepatotoxicity manifested by abnormal liver function tests, hepatitis and jaundice have been reported in some patients
- Gastrointestinal events including nausea, vomiting, diarrhea and oral ulceration may occur
- Avoid skin contact
- Avoid live vaccine administration during therapy
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Active infections
- Myelosuppression (extreme caution required)
- Myelosuppressive agent use
- CLL
- Elderly population
- Long term use (risk of leukemia, bone marrow dysplasia )
Pregnancy Category:D
Breastfeeding: Not recommended
30 mg/dL: Reduce dosage by 50% to reduce severe leukopenia and drug-related death
