Melphalan is a chemotherapy drug that is usually given to treat multiple myeloma. It's occassionally used to treat melanoma and ovarian cancer. This information should ideally be read with our general information about chemotherapy and your type of cancer.
What melphalan looks like
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Melphalan is a colourless fluid. It's also available as 2mg white tablets.
Melphalan may be given in one of the following ways:
as an injection through a fine tube (cannula) inserted into a vein (intravenously), usually in the back of your hand
through a fine, plastic tube inserted under the skin and into a vein near your collarbone (central line) or into a fine tube inserted into a vein in the crook of your arm (PICC line)
as tablets that should be swallowed whole on an empty stomach
into the abdominal space (intra-peritoneally) for some cancers - currently, it's only given this way as part of a clinical trial
into an artery in the arm or leg.
When melphalan is given into an artery in the arm or leg, you'll be put under general anaesthetic. A tight band is first applied to the top of the limb to prevent the chemotherapy from reaching other areas of the body. This procedure is known as isolated limb perfusion.
Chemotherapy is usually given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer you're being treated for. Your nurse or doctor will discuss your treatment plan with you.
Before you begin your treatment your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone who has melphalan and may be different if you're having more than one type of chemotherapy drug.
We have outlined the most common side effects but haven't included those that are rare and unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
Melphalan can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
Melphalan can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Melphalan can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea or vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate or drive machinery. You may find our section about coping with fatigue helpful.
Melphalan can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
Less common side effects
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Melphalan can cause changes in the way your liver works, although your liver will return to normal when the treatment has finished. Your skin and the whites of your eyes may become yellow (jaundiced). The doctor will take regular blood samples to check your liver is working properly.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect. You may also like to read our information about eating well.
This doesn't usually happen with melphalan tablets but can occur with high-dose intravenous treatment. Hair may get thinner or occasionally fall out completely. If this happens, it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. You may also have thinning and loss of eyelashes, eyebrows and hair in other areas of the body. This effect is usually temporary, and your hair will grow again once treatment ends. Your nurse can give you advice about coping with hair loss.
A skin rash can sometimes occur while you're having treatment with melphalan. It’s important to let your doctor know if this happens. Your doctor can prescribe medicine to help with this.
Changes to the lungs
The chemotherapy may cause some changes to the lungs. Tell your doctor if you smoke or if you notice any coughing or breathlessness.
Signs of an allergic reaction include skin rashes and itching, a high temperature (fever), shivering, redness of the face, dizziness, a headache, breathlessness, anxiety and a need to pass urine. An allergic reaction is unlikely to happen if you're only taking melphalan tablets. You'll be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of the symptoms mentioned above.
Possibility of leukaemia
With long-term use of melphalan, there's a very small risk of developing cancer of the white blood cells (leukaemia) after many years. After your treatment you’ll have regular blood tests to check for this.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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When melphalan is given into body cavities or by isolated limb perfusion, the side effects may be different from those mentioned in this section. Usually, the effects are mild or do not occur.
The appearance of the arm or leg may change after isolated limb perfusion. The limb may become swollen and darker in colour.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain.
Blood clots can be very serious, so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you're having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while taking melphalan as it may harm the developing baby. It’s important to use effective contraception while taking this drug and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Things to remember about melphalan tablets
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It is important to take your tablets at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you're taking a course of chemotherapy tablets that shouldn't be stopped without the advice of your cancer specialist.
Keep the tablets in their original packaging.
Melphalan tablets should be kept dry and stored in the refridgerator.
Keep the tablets in a safe place and out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
Let your doctor know if you're sick just after taking the tablet. Don't take another tablet without telling your doctor first.
If you forget to take a tablet, don't take a double dose. Inform your doctor and keep to your regular dose schedule.
This section is based on our melphalan fact sheet, which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2011).
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.