Melphalan is a chemotherapy treatment for a number of different cancers types. You might also have it before a stem cell or bone marrow transplant. It is also known as Alkeran.
What is Melphalan?
Melphalan is a chemotherapy drug. It is also known as Alkeran.
It is a treatment for a number of different cancer types. You might also have it before a stem cell or bone marrow transplant.
You might have melphalan on its own or with other cancer drugs.
How does Melphalan work?
Melphalan is one of a group of drugs called alkylating agents, which is a type of chemotherapy. Melphalan works by stickings to one of the cancer cell’s DNA 
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.
How do you have Melphalan?
You take melphalan as tablets or you have it into your bloodstream (intravenously).
You swallow the tablets whole on an empty stomach. You need to store the tablets in the fridge.
Taking your tablets
You must take tablets according to the instructions your doctor or pharmacist gives you.
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.
Into your bloodstream
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
- central line
- PICC line
- portacath
If you don’t have a central line
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
How often do you have melphalan?
You usually have melphalan as a course of several cycles of treatment. This means you have the drugs and then a rest to allow your body to recover. Your treatment plan depends on which type of cancer you have.
For example, if you have myeloma you often have melphalan as part of a combination of drugs, including a steroid (such as prednisolone) and a targeted drug (such as bortezomib). In this case, you take melphalan tablets for the first 4 days of each cycle of treatment. A cycle usually lasts 35 days (5 weeks). You usually have up to 8 cycles.
Some people might have high doses of melphalan with a stem cell transplant. You have high dose melphalan directly into your bloodstream (intravenously), usually through a central line.
Talk to your doctor, nurse or pharmacist to find out how you will be having melphalan.
Tests
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
What are the side effects of melphalan?
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you’re having.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Contact your advice line immediately if you have signs of infection, including a temperature above 37.5C or below 36C.
We haven’t listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
Common side effects
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of infection
Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
Breathlessness and looking pale
You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.
Bruising and bleeding
This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).
Feeling or being sick
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
This is usually mild if you take melphalan tablets, but can be more severe with melphalan through a drip.
A warm or tingling feeling along the vein
This can happen when having melphalan as a drip into your vein.
Diarrhoea
Contact your advice line if you have diarrhoea, such as if you’ve had 4 or more loose watery poos (stools) in 24 hours. Or if you can’t drink to replace the lost fluid. Or if it carries on for more than 3 days.
Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
Mouth sores and ulcers
Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep the mouth moist. Tell your doctor or nurse if you have ulcers.
Hair loss
You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before.
Muscle problems
Your muscles might ache or you may get muscle wasting when you have melphalan directly into your arm.
Less commonly some people get a condition called compartment syndrome. Symptoms include muscle pain, tightening, tingling, burning or numbness.
Let your treatment team know if you get any of these symptoms, so they can advise you on how to reduce them.
Occasional side effects
This side effect happens in between 1 and 10 out of every 100 people (between 1 and 10%).
You might have high levels of urea in your blood if you have kidney problems. You have regular blood tests to check for this.
Rare side effects
These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:
- liver changes that might only be picked up on blood tests or can cause symtpoms such as yellowing of the skin and whites of the eyes
- an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness – some allergic reactions can be life-threatening, alert your nurse or doctor if notice any of these symptoms
- a blood disorder where your red blood cells get destroyed faster than they can be made (haemolytic anaemia)
- skin rash and itchy skin
- lung problems such as coughing and wheezing
Other side effects
There isn’t enough information to work out how often these side effects might happen. You might have one or more of them. They include:
- a second cancer such as acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS)
- blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
- women might stop having their periods (amenorrhoea)
Coping with side effects
We have more information about side effects and tips on how to cope with them.
Important information
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
Alcohol
If you are having melphalan into your vein, its important to know that this preperation contains small amounts of alcohol. This is not harmful to most people but may be if you have alcohol problems.
Pregnancy and contraception
This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you’re having treatment and for at least 6 months afterwards.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner falls pregnant while having treatment.
Loss of fertility
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Breastfeeding
It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment. For example, if you need treatment for anything else, including teeth problems.
Immunisations
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.
You can have:
- other vaccines, but they might not give you as much protection as usual
- the flu vaccine (as an injection)
- the coronavirus (COVID-19) vaccine – talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment
Contact with others who have had immunisations – You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn’t possible, wash your hands well after changing their nappy.
What is Chemotherapy?
Chemotherapy is a type of anti cancer drug treatment. These drugs work by killing cancer cells. They work throughout your body and are called a systemic treatment.
Whether chemotherapy is a suitable treatment for you, and which drugs you might have, depends on:
- your type of cancer
- what the cancer cells look like under a microscope
- whether the cancer has spread
- your general health
You may have just one chemotherapy drug or a combination of different chemotherapy drugs. There are more than 100 different drugs currently available and new ones are being developed all the time. You may have chemotherapy with other types of cancer drugs.
Sometimes doctors use the word cytotoxic to describe the way chemotherapy works. Cytotoxic means cell killing.
How chemotherapy is used
You might have treatment with a single chemotherapy drug or a combination of drugs. The chemotherapy drugs you have depend on where in your body the cancer started (your type of cancer). This is because different drugs work on different types of cancer.
So the drugs you need for a cancer that started in the breast and has spread to the lung might be different to the drugs you would have for a cancer that started in the lung.
You might have chemotherapy on its own. Or you could have it with other treatments, such as:
- radiotherapy
- surgery
- hormone therapy
- targeted cancer drugs
- immunotherapy
- a combination of any of these treatments
You might also have high dose chemotherapy as part of a bone marrow or stem cell transplant.
Chemotherapy drug names
Generic names and brand names
Drugs have a generic name and they might also have one or more brand names.
- The generic name is the chemical name of the drug – for example, paracetamol
- The brand or trade name is the name given to the drug by the company that makes it – such as Panadol or Calpol
Drugs might be made by more than one company and so may have more than one brand name. For some drugs the brand or trade name is the most commonly used name. For other drugs the generic name is the most often used.
You can ask your chemotherapy nurse, pharmacist or doctor to tell you the generic name and the brand names of the drug they’re using in your treatment.
Combination chemotherapy names
Doctors often treat cancer with 2 or more chemotherapy drugs. Sometimes they also combine chemotherapy drugs with other medicines, such as steroids, immunotherapy or targeted cancer drugs.
The drug combinations they use often have a name that’s made up from the first letters of the drug names. This type of made up word is called an acronym.
Some combination chemotherapy names are simple, like MIC:
- M = mitomycin
- I = ifosfamide
- C = cisplatin
Not all acronyms are so obvious. One example is CHOP:
- C = cyclophosphamide
- H = doxorubicin
- O = vincristine (Oncovin)
- P = prednisolone, a steroid
Ask your doctor what each letter stands for. Ask them to write down the individual names of each drug in full. This will make it easier for you to find information about them.
Many cancer drug names begin with the same letter – and it’s important to be sure which drugs you’re having.
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