Canterbury DHB

Context

High Dose Melphalan

Melphalan is given on day –1, at a dose of 200 mg/m2 by slow IV bolus over no more than 30 minutes, into fast running saline. Melphalan is unstable in solution and its administration should be planned with pharmacy cytotoxics. Melphalan decomposes, and the rate of decomposition increases with increased temperature. It must be used immediately after making up, once reconstituted. It must be protected from light and it cannot be scheduled on Sunday or public holidays.

Adverse effects include nausea and vomiting, severe mucositis, pulmonary fibrosis (rarely). Hyperhydration is necessary prior to and after administration (see Melphalan IV Fluids chart).

Fluid retention and electrolyte imbalances are common during this conditioning schedule. Extra doses of frusemide are usually sufficient to treat fluid retention. Allopurinol is given to prevent urate nephropathy at a dose of 300 mg PO daily (adult dose). It is commenced on admission and continued until day -1. If vomited it should be readministered.

The antiemetics of choice are ondansetron (8 mg PO/IV q12h for adults) and dexamethasone 8 mg daily BD.

At least 24 hours must elapse after melphalan administration before stem cells are reinfused.

Adjustment for renal insufficiency. If there is renal impairment, discuss with the Consultant.

GFR

Percentage Dose (melphalan)

>50 ml/min

100

30-50 ml/min

50 -- but seek advice.

<30 ml/min

0*

*Discuss the advisability of proceeding with the SCT with the Consultant.

About this Canterbury DHB document (12607):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

December 2016

Next Review:

December 2018

Keywords:

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Topic Code: 12607