Side Effects of melphalan: A Synthesis of Findings from 18 Studies

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Original Abstract of the Article

Major Research Findings

Melphalan is a widely used chemotherapy drug for treating various cancers, including multiple myeloma. 2 、 13 、 5 . Melphalan works by damaging DNA and preventing cancer cells from multiplying. However, melphalan can also affect healthy cells, leading to side effects. 13 。High-dose melphalan (HDM) is particularly associated with severe gastrointestinal side effects, including diarrhea, nausea, and vomiting, which can limit the effectiveness of the treatment. 17 。The severity of these side effects is influenced by factors such as melphalan dosage, age, and underlying conditions. 17 。Further research is needed to find ways to manage these side effects effectively. 17 .

Reasons for Side Effects

Melphalan's side effects arise because it damages DNA in both cancer and healthy cells. 13 . The drug's mechanism of action involves disrupting DNA replication, which is essential for cell growth. While this is beneficial for targeting cancer cells, it can also harm normal cells, leading to various side effects. 13 .

Common Side Effects

Gastrointestinal Side Effects

Gastrointestinal side effects are a significant concern with melphalan treatment, especially high doses. 17 。Diarrhea, nausea, and vomiting are common symptoms experienced by patients undergoing treatment. 17 。Severe diarrhea (grade 2 or higher) can lead to prolonged hospital stays, dehydration, and a greater need for antibiotics. 17 。

Myelosuppression

Melphalan can also cause myelosuppression, a condition where the bone marrow produces fewer blood cells. 17 . This can lead to a decreased count of white blood cells, red blood cells, and platelets, increasing the risk of infections, anemia, and bleeding. 17 .

Stomatitis

Stomatitis, inflammation of the mouth's lining, is another potential side effect of melphalan treatment. 17 . This can cause pain, discomfort, and difficulty with eating and speaking. 17 .

Measures to Counter Side Effects

Gastrointestinal Side Effects

Managing gastrointestinal side effects involves using medications like antiemetics to reduce nausea and vomiting, and antidiarrheals to control diarrhea. 17 . Maintaining adequate hydration is also crucial. 17 . In severe cases, intravenous fluids may be necessary to address dehydration. 17 .

Myelosuppression

Preventing infections is vital for patients experiencing myelosuppression. 17 . This includes maintaining good hygiene, such as frequent hand washing, and avoiding close contact with sick individuals. 17 . Antibiotics may be administered to treat infections, and blood transfusions may be necessary to address anemia. 17 .

Stomatitis

Maintaining oral hygiene is essential for managing stomatitis. 17 . This includes regular brushing and gargling to keep the mouth clean and prevent dryness. 17 . Avoiding spicy and acidic foods and drinks can also help reduce discomfort. 17 .

Comparison of Studies

Commonalities among Studies

All studies reviewed indicate that melphalan is associated with various side effects, including gastrointestinal issues, myelosuppression, and stomatitis. 17 、 1 、 15 . The potential for these side effects is a common concern across different applications of melphalan therapy.

Differences among Studies

The specific side effects and their severity can vary based on the patient's individual characteristics, the dosage of melphalan, and the type of treatment regimen. 17 、 1 . For instance, higher doses of melphalan are generally linked to a greater risk and severity of side effects. 17 、 1 .

Precautions for Real-life Applications

Melphalan is a powerful chemotherapy drug, but its potential for causing side effects must be acknowledged. 13 . Before starting melphalan treatment, patients should have a thorough discussion with their doctor to understand the risks and how to manage any side effects that may occur. 13 .

Limitations of Current Research

While significant research has been dedicated to understanding melphalan side effects, there are still aspects that require further exploration. 13 . For example, the reasons for individual variability in side effect responses are not fully understood. 13 . Further research is needed to develop more accurate methods for predicting and preventing melphalan side effects. 13 .

Future Research Directions

Ongoing research is crucial to better understand melphalan side effects and develop strategies for minimizing them. 13 . Future research could focus on identifying genetic and environmental factors that contribute to side effect variability, exploring new drugs or therapies to mitigate side effects, and refining ways to personalize melphalan treatment to reduce individual risk. 13 .

Conclusion

Melphalan is a valuable tool in cancer treatment, but its side effects should not be overlooked. 13 . It's vital for patients to engage in open communication with their doctors to understand the potential risks and strategies for managing side effects. 13 . Continued research is essential for optimizing melphalan therapy and improving the lives of patients undergoing this treatment. 13 .

Literature analysis of 18 papers
Positive Content
15
Neutral Content
0
Negative Content
3
Article Type
1
0
0
3
18
1.

Population pharmacokinetics of melphalan and glutathione S-transferase polymorphisms in relation to side effects.

Author: KühneA, SezerO, HeiderU, MeinekeI, MuhlkeS, NiereW, OverbeckT, HohlochK, TrümperL, BrockmöllerJ, KaiserR

Melphalan efficacy
Diarrhea
Mucositis
Myelosuppression

This study investigated the relationship between melphalan pharmacokinetics, genetic polymorphisms, and side effects in patients undergoing treatment for multiple myeloma. The study found that melphalan dose was the most significant predictor of side effects, such as mucositis and diarrhea. Genetic polymorphisms were not reliable predictors of side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Genetic polymorphisms in the amino acid transporters LAT1 and LAT2 in relation to the pharmacokinetics and side effects of melphalan.

Author: KühneAnnett, KaiserRolf, SchirmerMarkus, HeiderUlrike, MuhlkeSabine, NiereWiebke, OverbeckTobias, HohlochKarin, TrümperLorenz, SezerOrhan, BrockmöllerJürgen

Multiple myeloma treatment

Genetic variations in the L-type amino acid transporters LAT1 and LAT2 may influence the effectiveness of melphalan, a commonly used drug for treating multiple myeloma.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Evaluation of the quality of life of adult patients admitted to the bone marrow transplantation unit.

Author: OzturkGozde Seray, RatipSiret, UmarRashida Muhammad, TezcanSongül

Anxiety

This study evaluated the quality of life of patients admitted to the bone marrow transplantation unit.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

5.

Liposome-Encapsulated Melphalan Exhibits Potent Antimyeloma Activity and Reduced Toxicity.

Author: LinZhimei, ChuBingyang, QuYing, WeiXue, HuangJingcao, WangFangfang, FengYu, WangXin, LuoHongmei, ZhaiXinyu, XuJuan, LiuXiang, ZhangLi, ChenFengjiao, WuYu, ZhengYuhuan

MM treatment
Organ toxicity

This study investigates the potential of liposomal melphalan (liposomal MEL) as a treatment for multiple myeloma (MM). Liposomal MEL showed similar anti-MM activity compared to free melphalan but with less organ toxicity in animal models. These findings suggest that liposomal MEL could be a promising drug modification for MM treatment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

7.

Addition of intravitreal carboplatin with melphalan for management of vitreous seeding in retinoblastoma.

Author: Riazi-EsfahaniHamid, MasoomianBabak, KhodabandehAlireza, AminiAbdulrahim, TaghizadehSara, BoujabadiLeila, SharifkashaniShervin, ShieldsCarol L, GhassemiFariba

Tumor control
Vitreous seed control
Cataract
Enucleation
Hypotony
Pigment dispersion
Retinal detachment

Carboplatin plus melphalan therapy may be effective in treating primary and refractory vitreous RB seeds with few toxic side effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

8.

Analysis of patient's X-ray exposure in hepatic chemosaturation procedures: a single center experience.

Author: EbelSebastian, ReinhardtMartin, BeeskowAnne Bettina, TeskeFelix, StruckManuel Florian, VeelkenRhea, van BoemmelFlorian, BergThomas, MocheMichael, GutberletMatthias, GößmannHolger, DeneckeTimm

Reduced systemic side effects
X-ray exposure

This institutional review analyzed the patient's X-ray exposure during hepatic chemosaturation. The procedure's radiation exposure was significantly influenced by the radiologist's experience, with more experienced radiologists requiring less dose-area-product (DAP) and fluoroscopy time (FT). Previous liver surgery also led to higher DAP/FT.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Choroidal occlusive vasculopathy after intraarterial chemotherapy: MRI findings.

Author: Roca-CabauM, Peralta CalvoJ, García MartínezF, López-VázquezA, D'AnnaO

Tumor control
COV
Choroidal thinning
Reduced eye length

Choroidal occlusive vasculopathy (COV) after intra-arterial chemotherapy (IAC) for retinoblastoma is associated with choroidal thinning and a reduction in eye length.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Triplet Therapy, Transplantation, and Maintenance until Progression in Myeloma.

Author: RichardsonPaul G, JacobusSusanna J, WellerEdie A, HassounHani, LonialSagar, RajeNoopur S, MedvedovaEva, McCarthyPhilip L, LibbyEdward N, VoorheesPeter M, OrlowskiRobert Z, AndersonLarry D, ZonderJeffrey A, MilnerCarter P, GasparettoCristina, AghaMounzer E, KhanAbdullah M, HurdDavid D, GowinKrisstina, KambleRammurti T, JagannathSundar, NathwaniNitya, AlsinaMelissa, CornellR Frank, HashmiHamza, CampagnaroErica L, AndreescuAstrid C, GentileTeresa, LiedtkeMichaela, GodbyKelly N, CohenAdam D, OpenshawThomas H, PasquiniMarcelo C, GiraltSergio A, KaufmanJonathan L, YeeAndrew J, ScottEmma, TorkaPallawi, FoleyAmy, FulcinitiMariateresa, HebertKyle, SamurMehmet K, MasoneKelly, MaglioMichelle E, ZeytoonjianAndrea A, NadeemOmar, SchlossmanRobert L, LaubachJacob P, Paba-PradaClaudia, GhobrialIrene M, PerrotAurore, MoreauPhilippe, Avet-LoiseauHervé, AttalMichel, AndersonKenneth C, MunshiNikhil C,

Progression-free survival
Adverse events

Adding autologous stem-cell transplantation (ASCT) to triplet therapy (lenalidomide, bortezomib, and dexamethasone [RVD]) was associated with longer progression-free survival (PFS) than RVD alone in patients with newly diagnosed multiple myeloma. The median PFS was 67.5 months in the transplantation group and 46.2 months in the RVD-alone group. No overall survival benefit was observed.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

13.

Alkylating Agents, the Road Less Traversed, Changing Anticancer Therapy.

Author: KaratiDipanjan, MahadikKakasaheb Ramoo, TrivediPiyush, KumarDileep

Side effects

This review explores the history and development of alkylating agents, a class of cancer chemotherapeutic drugs. It discusses their mechanism of action, structure-activity relationships, and the challenges of improving their efficacy and reducing side effects. The review highlights the ongoing efforts to design new alkylating agents with enhanced target specificity and bioavailability.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

14.

The Effect of Cryotherapy on the Prevention of Oral Mucositis and on the Oral pH Value in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation.

Author: BaysalEbru, SariDilek, VuralFiliz, ÇağırganSeçkin, SaydamGüray, TöbüMahmut, ŞahinFahri, SoyerNur, GedizFüsun, AcarlarCeylan, TimurEvin, GüngörAyşe

Oral mucositis prevention

This study evaluated the effectiveness of cryotherapy on the prevention of oral mucositis (OM) in patients with multiple myeloma undergoing autologous stem cell transplantation. Cryotherapy did not significantly change the incidence, severity, or duration of OM. Oral pH values were significantly different between the groups only before and one day after chemotherapy.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Controlled Clinical TrialA clinical trial that evaluates the effectiveness of a treatment by comparing a group that receives the intervention with a group that receives a placebo or standard treatment.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

15.

Selective Ophthalmic Artery Chemotherapy with Melphalan in the Management of Unilateral Retinoblastoma: A Prospective Study.

Author: Lumbroso-Le RouicLivia, BlancRaphaël, Saint MartinCaroline, SavignoniAlexia, BrisseHervé J, PierratNoëlle, Lévy-GabrielChristine, MatetAlexandre, DozFrançois, AertsIsabelle, CassouxNathalie

Globe preservation
Retinoblastoma treatment
Well tolerated
Ocular ischemic complications

Melphalan selective ophthalmic artery chemotherapy (SOAC) as first-line treatment for retinoblastoma was efficient and well tolerated, with no metastatic events but with some ocular ischemic complications observed.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

Results of isolated limb perfusion for metastasized malignant melanoma.

Author: SchellererVera S, FrengerJohannes, MerkelSusanne, GoehlJonas, KerstingStephan, GruetzmannRobert, ErdmannMichael, FoertschThomas

Melanoma treatment
Remission
Adverse events
Side effects

This study analyzed the results of hyperthermic isolated limb perfusion (HILP) in 80 patients with locoregional metastases of the extremities. HILP was effective in achieving remission, with a high response rate. The median overall survival rate was 33 months.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

18.

The Addition of Topotecan to Melphalan in the Treatment of Retinoblastoma with Intra-arterial Chemotherapy.

Author: StaceyAndrew W, De FrancescoSonia, BorriMelissa, HadjistilianouTheodora

Improved globe salvage

Adding topotecan to melphalan for the treatment of retinoblastoma using intra-arterial chemotherapy (IAC) did not alter the IAC side effect profile and may contribute to improved globe salvage.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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