Melphalan is a chemotherapy drug used to treat different types of cancer, including myeloma, melanoma, and ovarian cancer.

HOW IS MELPHALAN ADMINISTERED?

Melphalan is given in the chemotherapy day unit or during a hospital stay. A chemotherapy nurse will give it to you.

Before the day of treatment, a nurse will take a blood sample from you to see if you are fit for chemotherapy.

You will also be able to see a doctor or nurse before having chemotherapy. They will ask you how you have been feeling. If the results of your blood test are good on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will give you medication for nausea and, sometimes, steroids administered intravenously. Chemotherapy drugs may be given in the following ways:

• Through a thin tube (line) inserted into a vein in the arm or hand by a nurse
• Through a tube that goes below the skin of your chest to a nearby vein (central line)
• Through a thin tube that is placed in a vein of the arm and goes up through a vein toward the chest (PICC)

Into an artery in an arm or leg

When melphalan is injected into an artery in an arm or leg, it is done while the patient is under general anesthesia. The procedure is called regional arterial perfusion.

Your nurse will give you melphalan as a drip (perfusion) through a cannula or a line for about half an hour. This kind of drip is usually given using a perfusion pump for the sake of timing.

When the chemotherapy is given through a cannula or line

Some people may have the following side effects while they are having chemotherapy through a cannula or line:

ALLERGIC REACTION

Melphalan can cause allergic reactions. If you have an allergic reaction, it will be treated quickly. The signs of a reaction may include the following: rash, itchiness, reddening, or breathlessness; swelling in the face or lips; nausea; pain in the abdomen, back, or chest; or feeling unwell. Tell your nurse immediately if you have any of these symptoms.

PAIN ALONG THE VEIN

If you have pain, let your nurse know immediately. They will check the puncture side and will stop the drip in order to relieve the pain.

Taking melphalan as chemotherapy tablets

If you are to take melphalan in tablet form, your nurse or pharmacist will give you the tablets; always take these tablets as you are instructed. You will also be given drugs to control your dizziness.

Normally, you will take melphalan tablets once a day. Swallow them whole with a glass of water.

If you vomit right after taking the pills, get in touch with your hospital. You may have to take another dose. If you forget to take a pill, do not take a double dose. Keep your normal schedule and tell your doctor or nurse.

Other things to keep in mind about pills:

• Keep them in their original packaging.
• Store them in the refrigerator.
• Keep them safe and out of the reach of children.

Return the remaining pills to the hospital if the treatment is discontinued.

The chemotherapy is usually given as part of a course or cycle, consisting of several treatment sessions and lasting several months. The length of the treatment and the number of cycles you have will depend on the type of cancer you have. Your nurse or doctor will discuss your treatment plan with you.

POSSIBLE SIDE EFFECTS OF MELPHALAN

You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you receive other chemotherapy drugs, you may have other side effects that are not mentioned here. Always inform your doctor of the effects you experience.

Your doctor can prescribe medication to help control some of the side effects. It is very important to take the medication exactly as your doctor says for it to have the highest chance of working well. Your nurse will advise you on managing the side effects. After treatment, the side effects start to get better.

RISK OF INFECTION

Melphalan may lower the number of white blood cells in your blood. This will make you more susceptible to infection. Your nurse can tell you when you might have the lowest levels of these cells. When the number of white blood cells is low, this is called neutropenia.

Contact your hospital immediately if any of the following happens:

• your temperature goes above 38 ° C
• you suddenly feel unwell, even if your temperature is normal.
• You have symptoms of infection, which may include sore throat, coughing, or the need to urinate frequently.

The number of white blood cells normally increases gradually, returning to normal before your next chemotherapy session. You will have a blood test before your next chemotherapy. If your white blood cells are still low, your doctor may postpone the treatment for a short period of time.

BRUISING AND BLEEDING

Melphalan may lower the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any unexplained bleeding or bruising. This includes nosebleeds, bleeding gums, blood spots, or skin eruptions (rashes). Some people may require additional platelets.

ANEMIA

Melphalan may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this. If you are very anemic, it's possible you will require a blood transfusion.

TIREDNESS

Feeling very tired is a common side effect. Fatigue is often worst toward the end of treatment and for a few months after the treatment has finished. Try to pace yourself and rest as much as you need to. Help balance this with a bit of light exercise, such as short walks. If you feel drowsy, don't drive or operate heavy machinery.

NAUSEA

This can happen on the first few days after chemotherapy. Your doctor will prescribe you antiemetic drugs to help prevent or control your nausea. It is easier to prevent nausea than it is to treat it once it has begun.

If you still have nausea or are vomiting, get in touch with the hospital as soon as possible. They can give you advice and change your medication to one that works better.

DIARRHEA

Your doctor can prescribe medicines to control diarrhea. Let them know if your diarrhea is severe or if it doesn't get better. Make sure you drink at least two liters of fluids each day if you have diarrhea.

SORENESS OF THE MOUTH

You may have a sore mouth or mouth ulcers, which could make you more prone to getting a mouth infection. Lightly brush your teeth and/or dentures in the morning and night and after meals. Use a soft-bristle toothbrush. Your nurse might ask you to rinse your mouth out regularly or use mouthwash. It is important that you follow all the instructions you are given and that you drink a lot of fluids.

HAIR LOSS

Usually, people lose all of their hair. Also, the eyelashes, eyebrows, and other parts of the body may lose their hair. This normally starts after your first or second cycle of chemotherapy. It is almost always temporary, and the hair will continue to grow after you finish your chemotherapy. Until the time when you hair grows back, it is important to cover your head so as to protect the scalp while it is exposed to the sun's rays. Your nurse can give you advice on how to cope with losing your hair.

SKIN CHANGES

Chemotherapy can affect your skin. Melphalan can produce a rash, which may cause itchiness. If your skin is dry, try to use a fragrance-free moisturizing cream every day. Always tell your doctor about any change to your skin. These changes can be temporary, improving once the treatment is over.

CHANGES IN THE LIVER

Melphalan can affect the functioning of your liver. These changes are normally mild and return to normal after the treatment. You will have blood tests done to see how your liver is working.

LESS COMMON SIDE EFFECTS OF MELPHALAN

EFFECTS ON THE LUNGS

Melphalan can cause changes in the lungs. Always let your doctor know if you have wheezing, coughing, fever, or if you are out of breath. If necessary, tests can be done to check your lungs.

Tumor lysis syndrome (TLS)

High doses of melphalan can cause cancer cells to decompose very quickly. This releases uric acid (a waste product) into the blood. Uric acid is usually eliminated by the kidneys, though the kidneys may not be able to handle large quantities or uric acid. This can cause chemical imbalances in the blood, affecting the kidneys and heart. This is known as tumor lysis syndrome (TLS).

To reduce the risk of TLS, your doctor may give you a drug called rasburicase. You will also be given fluid through your drip in order to protect your kidneys.

You may have to have rasburicase with the first treatment. After this, you may take allopurinol in its place.

SECOND CANCER

Rarely, melphalan can increase the risk of developing a second cancer years down the road. Overall, however, the benefits of the treatment far outweigh this risk. Your doctor can talk to you about this.

MORE INFORMATION ABOUT MELPHALAN

BLOOD CLOT RISK

Cancer and chemotherapy increase the chances of a blood (thrombosis). The symptoms include pain, reddening or swelling in a leg, difficulty breathing, and pain in the chest. Get in touch with your doctor immediately if you have any of these symptoms.

OTHER DRUGS

Some medicines can interact with chemotherapy or be harmful if they are taken alongside chemotherapy. This includes medications that can be purchased in a store or pharmacy. Tell your doctor the medicines you are taking, including over-the-counter medications, complementary therapies, and herbal medicines.

FERTILITY

Melphalan may affect your fertility. If this worries you, you can talk to your doctor before beginning treatment.

CONTRACEPTION

Your doctor will advise you not to become pregnant during the treatment. This is because the drugs can harm developing babies. It is important to use contraception during chemotherapy and for a few months after the treatment ends.

SEX

If you have sex within the first few days after chemotherapy, it is necessary to use a condom. This is to protect your partner in case there is chemotherapy in semen or vaginal fluid.

BREASTFEEDING

Women are recommended not to breastfeed during treatment and for a few months after chemotherapy has concluded. This is in case the chemotherapy enters their breast milk.

MEDICAL AND DENTAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are having chemotherapy.

Talk to your cancer doctor or nurse if you think you need dental treatment. Always let your dentist know that you are having chemotherapy.