Alkeran

By Alice Chung, MD
Medically Reviewed by Yvonne Phan, PharmD, MBA
Last Update: January 16, 2025

What is Alkeran?

Alkeran is a prescription medication that contains the active ingredient melphalan, a type of chemotherapy drug used to treat certain types of cancer. It belongs to a class of drugs known as alkylating agents, which work by interfering with the DNA in cancer cells, preventing them from growing and multiplying. This DNA cross-linking agent is commonly prescribed for conditions such as multiple myeloma and ovarian cancer, and it is available in both tablet and injectable forms, depending on the specific treatment plan.

This medication plays a crucial role in slowing the progression of cancer and is often part of a comprehensive treatment strategy. The drug is also available as a generic option, providing a more affordable alternative without compromising effectiveness. If you’re considering this oncology medication as part of your treatment, consult your doctor to learn how it can help manage your specific condition and what to expect during therapy.

FAQ

What is Alkeran used for?

Alkeran, with the active ingredient melphalan, is a chemotherapy medication used to treat specific types of cancer. It helps slow or stop the growth of cancer cells. Doctors prescribe this anti-neoplastic agent for the following conditions:

• Multiple myeloma: A type of blood cancer affecting plasma cells.
• Ovarian cancer: Used to treat advanced cases of this type of cancer.
• Breast cancer: In certain situations, this cancer drug may be used as part of treatment.
• Melanoma: For advanced stages or in isolated limb infusion treatments.
• Polycythemia vera: A rare blood disorder involving an overproduction of red blood cells.

This chemotherapy alkylator can be used alone or in combination with other therapies, depending on the specific condition and treatment goals. Speak with your doctor to understand how it may fit into your care plan.

What is the chemical classification of melphalan?

How long does it remain in the body?

Melphalan, the active ingredient in Alkeran, has a relatively short half-life in the body, meaning it is processed and removed fairly quickly. After taking a dose, the medication typically reaches its peak concentration in the blood within 30 minutes to 2 hours. Its half-life—the time it takes for half of the drug to be eliminated—is approximately 1.5 to 2 hours for oral doses and 10 to 90 minutes for intravenous forms. This means that most of the medication is cleared from the body within a few hours, but its effects on cancer cells can last much longer.

The speed at which this alkylating agent is eliminated depends on factors like your liver and kidney function, age, and overall health. In people with kidney issues, the drug may take longer to leave the body, requiring dosage adjustments. If you have concerns about how long this drug remains in your system, your doctor can provide guidance tailored to your specific health needs.

How do I use Alkeran?

Alkeran (melphalan) is a chemotherapy medication that must be used exactly as prescribed by your doctor. It is available in tablet form or as an injection, depending on your treatment plan. To ensure the best results, it’s important to follow these key guidelines:

• Take at the same time daily if using tablets, with or without food, as directed by your doctor.
• Do not crush or chew tablets; swallow them whole with a glass of water.
• For injections, the medication is administered by a healthcare professional in a clinic or hospital.
• Drink plenty of water to stay hydrated and support your body during treatment.
• Avoid grapefruit or grapefruit juice, as it can interfere with how the medication works.
• Notify your doctor of any side effects, such as nausea, fatigue, or mouth sores, for proper management.
• Discuss other medications or supplements you are taking to avoid harmful interactions.

For the best results, stick to the treatment schedule provided by your doctor and attend all follow-up appointments to monitor your progress.

How much Alkeran can I use per day?

The daily dosage of melphalan depends on your specific condition, body weight, and overall treatment plan as prescribed by your doctor. For multiple myeloma, the typical dose is 0.15 mg per kilogram of body weight per day, taken as a single dose for 4 days. For ovarian cancer, the usual dose is 0.2 mg per kilogram of body weight daily, also for 4-5 days. These cycles are often repeated every 4-6 weeks, depending on your response to treatment and blood test results.

It is crucial not to exceed the prescribed dosage, as higher doses can increase toxicity and lead to serious side effects, including bone marrow suppression and gastrointestinal symptoms. Always take Alkeran exactly as directed by your healthcare provider, and report any side effects or concerns immediately. Your doctor may adjust your dose based on how your body responds to the medication and your overall health.

What is the success rate of melphalan?

The success rate of melphalan (Alkeran) varies depending on the condition being treated and the treatment regimen used. In patients with multiple myeloma, high-dose melphalan followed by autologous stem cell transplantation has been a standard treatment approach. Studies have shown that this regimen can lead to overall response rates of approximately 69%, with complete remission achieved in a subset of patients.

It’s important to note that individual responses to this cancer therapy agent can vary, and factors such as patient age, overall health, and disease stage can influence treatment outcomes. Additionally, the emergence of newer therapies and combination treatments continues to evolve the landscape of cancer treatment, potentially impacting success rates associated with melphalan-based regimens.

What is the recommended dosage?

The recommended dosage of Alkeran (melphalan) varies based on the condition being treated and individual factors. Below are general guidelines:

• Multiple myeloma:
  • Oral dose: 0.15 mg per kilogram of body weight per day.
  • Taken as a single dose for 4 days.
  • Repeated every 4-6 weeks based on response.
• Ovarian cancer:
  • Oral dose: 0.2 mg per kilogram of body weight daily.
  • Taken for 5 days.
  • Repeated every 4-6 weeks depending on progress.
• High-dose therapy (e.g., for stem cell transplantation):
  • Dosage is much higher and administered in a clinical setting.
  • Managed by healthcare professionals to ensure safety and effectiveness.

Always follow your doctor’s instructions precisely and attend scheduled check-ups to monitor your response. Never adjust the dosage on your own, as incorrect dosing can lead to serious side effects.

What is the generic name?

The generic name of Alkeran is melphalan, a widely used chemotherapy drug in 2025. Generic medication is highly popular due to its significantly lower cost compared to the brand-name version, while maintaining the same efficiency in treating conditions like multiple myeloma and ovarian cancer. Generic options are rigorously tested to ensure they meet the same quality, safety, and effectiveness standards as the branded medicine.

Patients choosing generic anti-cancer medication in 2025 can benefit from substantial savings without compromising their treatment outcomes. This makes it an excellent choice for those looking for cost-effective cancer therapy. If you’re considering switching to a generic version, consult your doctor or pharmacist to ensure it’s the right option for your treatment plan.

What are the side effects of Alkeran?

Alkeran can cause side effects that vary in severity. Understanding the potential effects can help you manage your treatment better. Below is a list of common and serious side effects, along with key details and occurrence rates:

• Nausea and vomiting: Affects up to 30-50% of patients. Anti-nausea medications can help manage this symptom.
• Bone marrow suppression: Affects up to 80% of patients, leading to low blood cell counts, anemia, increased infection risk, and bruising or bleeding. Regular blood tests are crucial to monitor this side effect.
• Diarrhea: Reported in 20-30% of patients, especially with higher doses. Staying hydrated and using anti-diarrheal medications can help.
• Mouth sores: Affects around 10-20% of patients. Good oral hygiene and special mouth rinses can reduce discomfort.
• Hair loss: Occurs in up to 15% of patients. This is usually temporary and resolves after treatment ends.
• Fatigue: Commonly reported and can vary in severity. Rest and proper nutrition are recommended.
• Infections: Increased risk due to weakened immunity, affecting about 20% of patients. Notify your doctor if you experience fever or signs of infection.

Less common but serious side effects include liver toxicity, allergic reactions, or secondary cancers with long-term use. Regular monitoring by your healthcare provider is essential to manage and minimize these risks effectively. If you experience any unusual or severe symptoms, contact your doctor immediately.

How toxic is melphalan?

Melphalan can be toxic, with its severity depending on the dosage and individual health factors. Bone marrow suppression is one of its most significant toxic effects, with up to 80% of patients experiencing reduced blood cell counts. This can lead to anemia, increased infection risk, and bleeding. Gastrointestinal toxicity, including nausea, vomiting, and diarrhea, occurs in up to 50% of patients, especially with higher doses or prolonged use.

High-dose melphalan, often used in stem cell transplants, is particularly associated with severe side effects. Studies indicate that 40-60% of patients experience dose-limiting gastrointestinal symptoms. Long-term toxicity can include damage to the bone marrow and an increased risk of secondary cancers, though this is less common. Regular monitoring by healthcare providers is crucial to manage these risks effectively.

What are the contraindications?

Alkeran should not be used in certain situations where it may pose serious health risks. Below is a list of key contraindications to consider:

• Allergy to melphalan or any ingredients in Alkeran: Using the drug can cause severe allergic reactions.
• Pregnancy and breastfeeding: Anti-cancer medication can harm the unborn baby or pass into breast milk, making it unsafe during these periods.
• Severely impaired liver or kidney function: The drug’s metabolism and elimination may be significantly affected, increasing toxicity risks.
• Active infections: Using this cytotoxic drug can weaken the immune system further, worsening infections.
• Low blood cell counts: Patients with pre-existing severe bone marrow suppression should avoid this tumor growth inhibitor unless advised by a doctor.

It’s essential to discuss your full medical history with your healthcare provider before starting cancer treatment to ensure it is safe and appropriate for your condition. If you fall into any of these categories, your doctor may suggest alternative treatments.

What is the success rate of Alkeran?

The success rate of Alkeran varies depending on the type and stage of cancer being treated, as well as individual patient factors. In multiple myeloma, high-dose melphalan followed by autologous stem cell transplantation is a common treatment approach. Studies have shown that this regimen can lead to overall response rates of approximately 69%, with complete remission achieved in a subset of patients.

For ovarian cancer, particularly in patients with BRCA1/2 mutations, this medication has demonstrated clinical activity. Research indicates that melphalan chemotherapy shows considerable effectiveness in this subset of patients, suggesting a potential benefit in heavily pre-treated, platinum-resistant epithelial ovarian cancer.

It’s important to note that individual responses to this anti-neoplastic agent can vary, and factors such as patient age, overall health, and disease stage can influence treatment outcomes. Additionally, the emergence of newer therapies and combination treatments continues to evolve the landscape of cancer treatment, potentially impacting success rates associated with Alkeran-based regimens.

Are there melphalan interactions?

Yes, melphalan (Alkeran) can interact with other medications, which may affect its effectiveness or increase the risk of side effects. Below is a list of common drug interactions to be aware of:

• Immunosuppressants (e.g., cyclosporine, tacrolimus): These drugs can increase the risk of infections when used with anti-cancer medication.
• Live vaccines (e.g., measles, mumps, rubella): The nitrogen mustard derivative can weaken your immune system, reducing the effectiveness of these vaccines and increasing infection risks.
• Warfarin and blood thinners (e.g., heparin): Combining these with melphalan may increase the risk of bleeding.
• Other chemotherapy drugs (e.g., cisplatin, cyclophosphamide): May enhance bone marrow suppression when taken with the nitrogen mustard derivative.
• Cimetidine: This heartburn medication may interfere with how your body processes the cytotoxic drug.

It’s important to inform your healthcare provider about all medications, supplements, and herbal products you are taking before starting cancer therapy. This ensures safe use and prevents harmful interactions.

Does this drug always cause hair loss?

Melphalan (Alkeran) does not always cause hair loss; the likelihood depends on the dosage and treatment regimen. In high-dose treatments, such as those used before stem cell transplants, nearly all patients experience significant hair loss. Hair typically begins to fall out within 10-15 days after starting treatment and usually starts to regrow after 10-12 weeks.

Patients receiving lower doses of melphalan, such as oral forms, may experience minimal or no hair loss. Studies suggest that hair thinning or loss is less common with these doses and generally begins within 2-4 weeks of treatment. Hair loss caused by this alkylating agent is almost always temporary, with regrowth starting approximately one month after completing treatment. If hair loss is a concern, speak with your doctor about strategies to manage or minimize this side effect.

How much does Alkeran cost?

As of 2025, the cost of this cancer-fighting drug varies depending on the dosage and pharmacy. A 2 mg tablet of brand-name Alkeran typically costs between $250 and $350 per tablet, making a full course of treatment several thousand dollars. The overall price can also depend on whether you have insurance or access to financial assistance programs.

For those looking to save money, generic melphalan is a more affordable alternative with the same effectiveness. Generic versions can cost between $50 and $100 per tablet or even less, offering significant savings compared to the brand-name version. Choosing generic options is a popular choice in 2025 for cost-conscious patients. Speak with your doctor or pharmacist about generic medication to explore a budget-friendly option for your treatment.

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About the Author

Dr. Alice P. Chung, MD, is a renowned surgical oncologist in Beverly Hills, California, with over 20 years of experience. Affiliated with Cedars-Sinai Medical Center, she specializes in oncology and surgical oncology, with expertise in mastectomy and complex oncologic conditions. A 2000 graduate of Chicago Medical School, Dr. Chung completed her surgical residency at Cedars-Sinai, mastering advanced techniques. Board-certified in surgery and a Fellow of the American College of Surgeons (FACS), she is recognized for her compassionate care and clinical excellence. Licensed in California and New York, she is also certified in CMS Meaningful Use Stage 1 through EpicCare EMR. Known for her dedication to innovative surgical solutions and patient-centered care, Dr. Chung is highly regarded by patients and colleagues for her expertise and personalized approach. She remains committed to advancing the field of surgical oncology through both her clinical practice and advocacy for cutting-edge treatments.

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Disclaimer: This page provides general information and is not intended to replace professional medical advice, diagnosis, or treatment. Consult a qualified healthcare professional for personalized medical guidance. Never disregard or delay seeking advice from a healthcare provider due to something you have read here.