Melphalan (Alkeran)

Melphalan is a treatment for several different types of cancer, including multiple myeloma, breast cancer and ovarian cancer. Its brand name is Alkeran. It is one of a group of drugs called alkylating agents. It sticks to one of the cancer cell's DNA (the cell's genetic code) strands. DNA is the genetic code that is in the nucleus of all animal and plant cells. It controls everything the cell does. The cell cannot then grow and divide into 2 new cells.

Melphalan is a clear liquid that you have as a drip (intravenous infusion). You may have it through a short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drug directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it. 

Melphalan also comes as white tablets that you take on an empty stomach. You should store your tablets in the fridge. It is very important that you take tablets according to the instructions your doctor or pharmacist gives you. For example, whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream. You should take the right dose, not more or less. And never stop taking a cancer drug without talking to your specialist first.

You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for melphalan depends on which type of  cancer you have. There is detailed information about how doctors plan chemotherapy in this section.

The side effects of melphalan are listed below. You can use the links to find out more about each side effect or go to the cancer drug side effects section.

More than 10 in every 100 people have one or more of the side effects listed below.

Temporary drop in the number of blood cells made by the bone marrow, causing

• Increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Feeling or being sick happens to about 1 in 3 people (33%) and is usually mild if you take melphalan tablets, but can be more severe with melphalan through a drip, especially high dose treatment – tell your doctor or nurse if your anti sickness medicine isn't helping because there are other medicines you can try
• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your doctor or chemotherapy nurse immediately
• Melphalan may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Women having melphalan should not breastfeed as the drug may come through in the milk
• Women may stop having periods (amenorrhoea), but this may only be temporary
• Diarrhoea is only common with high dose melphalan – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
• A sore mouth and mouth ulcers are common with high dose melphalan

Fewer than 1 in 100 people have these.

• Hair loss, but this only happens with high dose melphalan through a drip
• An allergic reaction happens to about 1 in 100 people (1%) having melphalan through a drip – you may have a drop in blood pressure, a fast pulse, wheezing and breathlessness
• Liver changes that are very mild and unlikely to cause symptoms – the liver usually goes back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working
• There is a small risk of getting another cancer in the future after treatment with melphalan, but do remember that the risk is very small compared to the risk to your health of the cancer you're having treatment for
• A blood disorder called haemolytic anaemia
• Inflammation of the lungs – tell your doctor if you notice any difficulty breathing
• A skin rash

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment. Or you may develop more side effects as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your chemotherapy nurse, clinic or ward nurse will give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – some drugs can react together.

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.