Alkeran Disease Interactions

Because of their cytotoxic effects on rapidly proliferating tissues, antineoplastic agents frequently can, to varying extent, induce myelosuppression. The use of these drugs may be contraindicated in patients with known infectious diseases. All patients should be instructed to immediately report any signs or symptoms suggesting infection such as fever, sore throat, or local infection during antineoplastic therapy. Close clinical monitoring of hematopoietic function is recommended.

Bone marrow suppression is the most significant toxicity associated with melphalan in most patients. The following tests should be performed at the start of therapy and prior to each subsequent dose of melphalan: platelet count, hemoglobin, white blood cell count, and differential. Thrombocytopenia and/or leukopenia are indications to withhold further therapy until the blood counts have sufficiently recovered. Frequent blood counts are essential to determine optimal dosage and to avoid toxicity. Dose adjustment on the basis of blood counts at the nadir and day of treatment should be considered.

Interstitial pneumonitis and/or fibrosis (including fatal outcomes), have been reported occasionally during melphalan therapy. Therapy with melphalan should be administered cautiously in patients with or predisposed to pulmonary dysfunction.

The incidence of myelosuppression, particularly during IV administration of melphalan, is increased in patients with a BUN > 30 mg/dl. Therapy with melphalan should be administered cautiously and initiated at a reduced dosage in patients with moderate to severe renal impairment. Clinical monitoring of renal function is recommended.