What is it used for?
Alkeran is indicated for the palliative treatment of multiple myeloma and for the palliation of non-resectable epithelial carcinoma of the ovary.

Contraindications and cautions:

Make sure you tell your doctor if you have any other medical problems, especially:
• Chickenpox (including recent exposure) or
• Herpes zoster (shingles)—Risk of severe disease affecting other parts of the body
• Gout (history of) or
• Kidney stones (history of)—Melphalan may increase levels of a chemical called uric acid in the body, which can cause gout or kidney stones
• Infection—Melphalan decreases your body's ability to fight infection
• Kidney disease—Risk of toxic effects on the blood may be increased
Melphalan can lower the number of white blood cells in your blood temporarily, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding.

Side effects: All medicines can have side effects.
Hematologic: The most common side effect is bone marrow suppression leading to leukopenia, thrombocytopenia, and anemia. Although bone marrow suppression frequently occurs, it is usually reversible if melphalan is withdrawn early enough. However, irreversible bone marrow failure has been reported.
Gastrointestinal: Nausea, vomiting, diarrhea, and oral ulceration occur. Hepatic disorders ranging from abnormal liver function tests to clinical manifestations such as hepatitis and jaundice have been reported.
Miscellaneous: Other reported adverse reactions include: pulmonary fibrosis (including fatal outcomes) and interstitial pneumonitis, skin hypersensitivity, maculopapular rashes, vasculitis, alopecia, and hemolytic anemia. Allergic reactions, including urticaria, edema, skin rashes, and rare anaphylaxis, have occurred after multiple courses of treatment. Cardiac arrest has also been reported rarely in association with such reports.

Interactions: Tell your doctor if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop. Before taking melphalan, tell your doctor if you are being treated with any other medicines that weaken your immune system, such as:
• cyclosporine (Gengraf, Neoral, Sandimmune);
• radiation therapy;
• steroids (prednisone and others); or
• another chemotherapy medicine.