Melphalan is a chemotherapy drug that is given as a treatment for some types of cancer. It's mainly used to treat multiple myeloma, melanoma, ovarian and breast cancer. This information describes melphalan, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give further information and advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Melphalan is a colourless fluid. It is also available as white tablets of 2mg.

Melphalan may be given:

• as an injection into a vein (intravenously) through a fine tube (cannula) inserted into the vein, usually in the back of the hand
• through a fine plastic tube that is inserted under the skin into a vein near the collarbone (central line) or into a fine tube that is 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 cavity (intraperitoneally)
• Into an artery in the arm or leg.

When melphalan is given into an arm or leg, you will 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 (or 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 for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given melphalan and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects as well as rarer ones, so that you can be aware of them if they occur. However, we have not included those that are very rare, and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor, chemotherapy nurse or pharmacist.

Lowered resistance to infection Melphalan can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given and usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straight away if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is still low.

Bruising or bleeding Melphalan can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with melphalan you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these symptoms are a problem.

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin soon after the treatment is given and last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting. If the sickness isn't controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Your liver may be temporarily affected Melphalan can cause changes in the way that 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). Your doctor will monitor the function of your liver by taking samples of your blood.

Sore mouth and ulcers Your mouth may become sore, 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 to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicine to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea This can usually be easily controlled with medicine, but let your doctor know if it is severe or if it continues. It's important to drink plenty of fluids if you have diarrhoea.

Hair loss This doesn't usually happen with melphalan tablets, but can occur with highdose 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 other body hair. This effect is temporary, and your hair will grow again once treatment ends. Your nurse can give you advice about coping with hair loss.

Skin changes Melphalan can cause a rash, which may be itchy. Your doctor can prescribe medicine to help with this.

Allergic reaction Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, a headache, breathlessness, anxiety and a need to pass urine. An allergic reaction is unlikely to happen if you are only taking melphalan tablets. You will 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.

Changes to the lungs Melphalan may cause some changes to the lung tissue. Tell your doctor if you notice any coughing or breathlessness.

Possibility of leukaemia With long-term use of this drug there is a very small risk of developing leukaemia (cancer of the white blood cells) after many years. After your treatment you will have regular blood tests which will detect if you start to develop leukaemia.

When melphalan is given into body cavities, or by isolated limb perfusion, the side effects may be different from those mentioned here. 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 blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having 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 is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines can be harmful to take when you are having chemotherapy (including those you can buy in a shop or chemist). Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking melphalan, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

• The tablets should be stored in a refrigerator and kept dry.
• Keep the tablets in a safe place where children cannot reach them, as melphalan could harm them.
• It is important to take your tablets at the right times. You must take them as directed by your doctor.
• If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the tablet let your doctor know, as you may need to take another dose. Do not take another tablet without first telling your doctor.
• If you forget to take a tablet, do not take a double dose. Tell your doctor and keep to your regular dose schedule.

This section is based on our Melphalan factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Medicines.org.uk website – www.medicines.org.uk (November 2008).
• The Chemotherapy Source Book (4th edition). Ed. Perry. Lippincott Williams and Wilkins, 2007.

For further references, please see general bibliography.