Alkeran

Generic name: Melphalan
Trade name: Alkeran
Other names:
Drug type: Alkeran 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 heart of all animal and plant cells. It controls everything the cell does. The cell cannot then divide into 2 new cells. 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 heart of all animal and plant cells. It controls everything the cell does. The cell cannot then divide into 2 new cells. Melphalan is a clear liquid that you have as a drip (intravenous infusion) through a small tube in a vein in your arm, or through a central line. It also comes as white tablets that you take on an empty stomach. You should store your tablets in the refrigerator. You usually have chemotherapy as a course of several cycles of treatment. The treatment plan for melphalan depends on which cancer you are being treated for.

Common side effects

Many people have one or more of the following side effects

• Fatigue can be the most troublesome side effect of all - it often carries on after treatment has ended, but most people find their energy levels are back to normal from 6 months to a year after their treatment finishes
• Temporary effect on the bone marrow causing:
  • An increased risk of getting infections due to a temporary drop in the number of white blood cells made by the bone marrow. Having a low white blood count means that you are less able to fight infections and can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. Infections can sometimes be life threatening. Contact your doctor urgently if you think you have an infection.
  • Tiredness and breathlessness due to a drop in the number of red blood cells made by your bone marrow (anaemia) - you may need a blood transfusion
  • Bruising more easily due to a drop in the number of platelets made by your bone marrow. You may have lots of tiny red spots or bruises on your arms or legs, nosebleeds or bleeding gums when brushing your teeth.

Contact your hospital if you have any of these bone marrow side effects.

• Feeling or being sick happens to about 1 in 3 people treated and is usually mild if you take melphalan tablets, but can be more severe with melphalan through a drip, especially high dose treatment - do tell your doctor if your anti-sickness medicine isn't helping as there will be others you can try
• Redness, pain and swelling at the site of your drip – tell your chemotherapy nurse straight away if you notice this
• Harm to a developing baby - it is important not to get pregnant or father a child during treatment with melphalan. Talk to your doctor about contraception
• Loss of fertility - you may not be able to get pregnant or father a child after treatment with this drug, so it is important to talk to your doctor about your fertility before starting treatment
• 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 if it becomes severe or lasts for more than a couple of days as you could become dehydrated
• Sore mouth and mouth ulcers are common with high dose melphalan Rare side effects A small number of people have the following side effects
• 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
• 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
• Inflammation of the lungs – tell your doctor if you notice any difficulty breathing
  
• A skin rash, but this is uncommon

Important points to remember

The side effects above may be mild or more severe. A side effect may get
better or worse through your course of treatment, or more side effects may
develop 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

Some side effects are inconvenient or upsetting but not damaging to your health. Some side effects are serious medical conditions and need treating.

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

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.

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 have given 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.

Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these 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 from your chemotherapy.

It is perfectly 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 no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.

Copyright Cancer Research UK 2002
Cancer Research UK Charity Number 1089464