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.


About this Canterbury DHB document (12607):
Document Owner:	Andrew Butler (see Who's Who)
Last Reviewed:	December 2016
Next Review:	December 2018
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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GFR	Percentage Dose (melphalan)
>50 ml/min	100
30-50 ml/min	50 -- but seek advice.
<30 ml/min	0*