Myelostem 2 Tablet

Description of Myelostem 2 (Melphalan 2 mg) tablet

Myelostem 2 tablet contains Melphalan which is an antineoplastic drug of the alkylating agent type of which is a derivative of nitrogen mustard. It is commonly applied in treating hematological malignancies like multiple myeloma and ovarian cancer. Melphalan has a cytotoxic effect that is brought about by covalent bonding with DNA resulting in the cross-linking of the strands of DNA. This disrupts the DNA replication and transcription and eventually suppresses cell division and cancer cell apoptosis.

Melphalan is said to be a strong cytotoxic drug and acts on both malignant and normal fast dividing cells especially those in the bone marrow, hence the reason it has a significant toxicity profile. It is also employed in high dosage regimen as a form of conditioning therapy prior to transplanting a stem cell.

Indications of Myelostem 2 (Melphalan 2 mg) tablet

Melphalan can be applied in multiple myeloma and ovarian cancer or in conditioning prior to bone marrow or stem cell transplantation. It can also be applied in some other malignancies at the discretion of the clinical judgment.

Mechanism of action of Myelostem 2 (Melphalan 2 mg) tablet

Melphalan is an alkylating agent which covalently interacts with the DNA at the N7 site of guanine. This leads to cross linking of DNA intra and inter strands, disrupting the DNA structure and functioning. The damage inhibits cell division, causes apoptosis and inhibits DNA replication and transcription.

Melphalan is a non-cell cycle specific but more effective on cell with a rapid division thus applicable in cancer treatment.

How to consume Myelostem 2 (Melphalan 2 mg) tablet

Melphalan can be administered orally or intravenously with regard to the treatment regimen. Tablets in the form of oral pills must be taken without eating food as it may slow its absorption. The dosage is computed depending on the body surface area or body weight and is administered in cycles under the strict medical supervision. The supportive care that is necessary with high dose therapy includes hydration and monitoring.

Side Effects of Myelostem 2 (Melphalan 2 mg) tablet

1. Common Side Effects

• Nausea
• Vomiting
• Loss of appetite
• Fatigue

2. Serious Side Effects

• Bone marrow suppression (anemia, leukopenia, thrombocytopenia)
• Severe infections
• Gastrointestinal toxicity

3. Rare Side Effects

• Secondary malignancies (especially leukemia)
• Hypersensitivity reactions
• Pulmonary fibrosis

Safety Advice for Myelostem 2 (Melphalan 2 mg) tablet

Melphalan is a potent cytotoxic agent, especially on bone marrow which makes patients receiving Melphalan highly monitored. To identify the early symptoms of myelosuppression, routine counts of the blood are necessary.

Breastfeeding: Melphalan should not be administered in the presence of breastfeeding being done since it can be transferred to the breast milk and be harmful to the baby.

Pregnancy: Contraindicated because of teratogenic effects and chances of fetal injury.

Alcohol: It is advisable to avoid alcohol that can increase the gastrointestinal irritation and increase the stress to the liver.

Liver: Liver is primarily removed by the chemical degradation, however liver activity should still be monitored as there still is a chance of toxicity.

Lungs: There is possible rare pulmonary toxicity, which patients should report (i.e., cough or breathlessness).

Kidney: The kidney performance is to be observed, especially when the treatment is high doses as clearance is compromised and this could increase the toxicity.

Driving: Patients might feel fatigued or weak; they should not drive in case of the symptoms.

Interaction of Myelostem 2 (Melphalan 2 mg) tablet

• Drug–Drug Interaction

Other myelosuppressive drugs × Melphalan
Combination with other cytotoxic agents or radiotherapy can greatly enhance bone marrow suppression resulting in severe anemia, infection and bleeding.

Live vaccines × Melphalan

Melphalan inhibits the immune response and introduction of live vaccines can cause severe infections because of decreased immune response.

Nalidixic acid × Melphalan

May predisposes to serious gastroenterological toxicity, and hemorrhagic enterocolitis in children.

Cyclosporine × Melphalan

May suppress immunity and become prone to infections.

• Drug–Food Interaction

Food can reduce absorption of oral Melphalan and hence it is preferable to have an empty stomach when taking oral Melphalan. It is recommended that proper hydration should be used during treatment.

• Drug–Disease Interaction of Myelostem 2 (Melphalan 2 mg) tablet

Bone marrow disorders:
Melphalan causes extreme bone marrow suppression, thus exacerbating underlying conditions, thereby causing serious anemia, infections and bleeding complications.

Renal impairment:

Increased toxicity and level of drugs can be caused by the absence of the renal functioning. Adjustment of the dose might be required.

Infections:

Immunosuppressive effects of Melphalan can cause worsening of patients with active infections.

Pulmonary disease:

Pulmonary toxicity can develop with Melphalan particularly with prolonged use of the drug, and it should be used with caution in patients with underlying lung diseases.

Contraindication of Myelostem 2 (Melphalan 2 mg) tablet

Should not be used in hypersensitivity, extreme bone marrow suppression, and pregnancy.

Dosage of Myelostem 2 (Melphalan 2 mg) tablet

The dosage depends on the body surface area or weight. It is administered in cycles under the control of medicine.

Storage of Myelostem 2 (Melphalan 2 mg) tablet

Store in a dry place at room temperature.

Missed Dose of Myelostem 2 (Melphalan 2 mg) tablet

In case of a missed dose, it is preferable to take it as early as possible other than near the next dose. Do not double dose.

Other General Information of Myelostem 2 (Melphalan 2 mg) tablet

Patients are to visit regularly as a follow up. Fever, unusual bleeding, or sudden severe fatigue are some of the symptoms that ought to be reported as soon as possible.

FAQs of Myelostem 2 (Melphalan 2 mg) tablet

1. What is bone marrow suppression caused by Melphalan?

Due to its action on fast-dividing cells, such as in bone marrow cells which produce blood cells.

2. What is its use in multiple myeloma?

As it is a good antiprolliferative of abnormal plasma cells.

3. Does Melphalan have secondary cancer?

Yes, secondary leukemia may be risked by long-term use.

4. What is the reason why it should be taken on empty stomach?

It is due to the fact that food decreases its absorption and effectiveness.

5. Why is monitoring important?

In order to identify early-toxicity and modify dose.

Fact Box of Myelostem 2 (Melphalan 2 mg) tablet

References

• FDA Prescribing Information – Melphalan
  https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/020813s019lbl.pdf
• European Medicines Agency (EMA) – Melphalan Product Information
  https://www.ema.europa.eu/en/documents/product-information/Melkeran-epar-product-information_en.pdf
• DrugBank – Melphalan
  https://go.drugbank.com/drugs/DB01042
• National Cancer Institute (NCI) – Melphalan
  https://www.cancer.gov/about-cancer/treatment/drugs/melphalan