Melphalan flufenamide 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 flufenamide in most patients. It is recommended to perform the following tests at the start of therapy and prior to each subsequent dose of melphalan flufenamide: platelet count, hemoglobin, white blood cell count, and differential. Thrombocytopenia and/or neutropenia are indications to withhold further therapy until the blood counts have sufficiently recovered. Monitor blood counts frequently to determine optimal dosage and to avoid toxicity. Consider prophylactic therapy such as leukocyte growth factor as clinically appropriate. Dose adjustment on the basis of blood counts at the nadir and day of treatment should be considered.

No dose adjustment of melphalan flufenamide is recommended in patients with creatinine clearance (CrCl) 45 to 89 mL/min. Care should be exercised when using this agent in patients with CrCl 15 to 44 mL/min as the safety and efficacy has not been studied in these patients.