Melphalan (Alkeran)

• What melphalan is
• Common side effects
• Rare side effects
• Important points to remember
• Immunisations and chemotherapy

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. There is more about how doctors plan chemotherapy in this section of CancerHelp UK.

The side effects of melphalan are listed below. You can use the links to find out more about each side effect or click on search at the top of the page.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• 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).

These effects on your bone marrow can begin about 7 days after each treatment and usually go back to normal after about 21 to 28 days. Some of these side effects can be life threatening, particularly infections.  You should contact your doctor if you have any of these side effects.  Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

• 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
• 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
• 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
• 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

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

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. Where we have urged you to contact your doctor, this is because

• 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.

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.