Melphalan (Alkeran)

General information

Class/mechanism: Nitrogen mustard, alkylator. Melphalan is a bischloroethylamine alkylating agent that crosslinks DNA by binding at the N7 position of guanine, with activity against resting and proliferating cells.
Route: IV, PO
Extravasation: irritant or neutral, depending on reference

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias or the prescribing information.

Diseases for which it is established

• Plasma cell dyscrasia
  • Light-chain (AL) amyloidosis
  • Multiple myeloma (FDA)
  • Plasma cell leukemia

Diseases for which it is used

• Acute myeloid leukemia
• Acute promyelocytic leukemia
• Ewing sarcoma
• Classical Hodgkin lymphoma
• Neuroblastoma
• Non-Hodgkin lymphoma
  • CNS lymphoma
  • Diffuse large B-cell lymphoma
  • HIV-associated lymphoma
  • Indolent lymphoma
    • Follicular lymphoma
  • Mantle cell lymphoma
  • Peripheral T-cell lymphoma

Diseases for which it was used

• Breast cancer
• Ovarian cancer (FDA)

Patient drug information

• Melphalan (Alkeran) patient drug information (Chemocare)
• Melphalan (Alkeran) patient drug information (UpToDate)

History of changes in FDA indication

• 1964-01-17: Initial FDA approval
• Uncertain date: Indicated for the palliative treatment of multiple myeloma. (Based on SWG01)
• Uncertain date: Indicated for the palliation of non-resectable epithelial carcinoma of the ovary. (No supporting studies are cited)

History of changes in EMA indication

• 1963-09-26: EURD

Also known as

• Generic names: L-PAM, L-Sacrolysin, L-Sarcolysin, MPL, phenylalanine mustard
• Brand names: Alkeran, Alkerana, Evomela, Levofolan, Melfalan, Phelinun