Adult Dosing
Chemotherapy
- Dosage varies with clinical situation, response and hematologic depression
- 0.4 mg/kg ideal body weight IV per course of therapy as a single dose or in divided doses as 0.1-0.2 mg/kg/day; may repeat q3-6 wks
Advanced Hodgkin's disease (MOPP regimen)
- 6 mg/m2 IV on days 1 and 8 of 28-day cycle. Subsequent doses are based on leukocyte and platelet counts
Malignant effusions
- Usual intracavitary dose is 0.4 mg/kg
- Usual intrapericardial dose is 0.2 mg/kg (10-20 mg)
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Obtain an accurate histologic diagnosis of the disease, its natural course and adequate clinical history before starting treatment. Carefully weigh anticipated benefits with expected risks
- Since nitrogen mustard therapy can contribute to extensive and rapid development of amyloidosis, it should be used only if foci of acute and chronic suppurative inflammation are present
- Nitrogen mustard therapy may be associated with an increased incidence of second malignant tumor
- Mechlorethamine can cause fetal harm when administered to a pregnant woman. Advise women of child bearing potential to avoid becoming pregnant during therapy
- Therapy with mechlorethamine is associated with significant hematologic toxicities. Lymphocytopenia occurs within 24 hrs after the first injection; significant granulocytopenia occurs within 6 to 8 days and lasts for 10 days to 3 wks. Erythrocyte and hemoglobin levels may decline, during the first 2 wks after therapy. Depression of the hematopoietic system may occur up to 50 days or more after starting therapy
- It is possible for repeated courses of therapy as early as three weeks after treatment. However, subsequent courses should not be given until patient has recovered hematologically from previous course
- It is a highly toxic drug. Follow special handling procedures for administration (US Black Box Warning)
- If contact with skin occurs, copius irrigation for atleast 15 mins with water, followed by 2% sodium thiosulphate is recommended. Contaminated clothing should be destroyed
- If accidental eye exposure occurs, copius irrigation for atleast 15 mins with water, normal saline or a balanced salt opthalmic irrigating solution , followed by prompt ophthalmic consultation is recommended
- Monitor renal, hepatic and bone marrow function periodically during treatment
Cautions: Use cautiously in
- Myelosuppression (extreme caution required)
- Myelosuppressive agent use
- Decreased bone marrow reserve
- Obesity
- Edema
- Elderly population
- Gout
- Chronic lymphatic leukemia (extreme caution required due to risk of myelosuppression)
- Previous chemotherapy and XRT
Pregnancy Category:D
Breastfeeding: Most sources consider breastfeeding to be contraindicated with antineoplastic therapy. Due to the potential to cause serious adverse events, it is recommended that patients receiving mechlorethamine should not breastfeed.
