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antineoplastic drug (trade name Alkeran) used to treat multiple myeloma and some other malignancies (同)Alkeran

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/12/14 16:27:37」(JST)

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Melphalan hydrochloride (trade name Alkeran) is a chemotherapy drug belonging to the class of nitrogen mustard alkylating agents.

An alkylating agent adds an alkyl group (C_nH_2n+1) to DNA. It attaches the alkyl group to the guanine base of DNA, at the number 7 nitrogen atom of the imidazole ring.

Otherwise known as L-Phenylalanine Mustard, or L-PAM, melphalan is a phenylalanine derivative of mechlorethamine.

Uses

It is used to treat multiple myeloma^[1] and ovarian cancer, and occasionally malignant melanoma.

The agent was first investigated as a possible drug for use in melanoma. It was not found to be effective, but has been found to be effective in the treatment of myeloma.

Administration

Oral or intravenous; dosing varies by purpose and route of administration as well as patient weight.

Melphalan Prescribing Information: Alkeran^[2]

Melphalan Patient Information: MedlinePlus^[3]

Melphalan Material Safety Data Sheet (MSDS): Sequoia Research Products^[4]

Side effects

Common side effects include:

Nausea and vomiting, and oral ulceration.
Bone marrow suppression, including
- Decreased white blood cell count causing increased risk of infection
- Decreased platelet count causing increased risk of bleeding

Less common side effects include:

Severe allergic reactions
Pulmonary fibrosis (scarring of lung tissue) including fatal outcomes (usually only with prolonged use)
Hair loss
Interstitial pneumonitis
Rash
Itching
Irreversible bone marrow failure due to melphalan not being withdrawn early enough.
Cardiac arrest.

References

^ Facon T, Mary JY, Hulin C, et al. (October 2007). "Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial". Lancet 370 (9594): 1209–18. doi:10.1016/S0140-6736(07)61537-2. PMID 17920916. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(07)61537-2.
^ celgene.com
^ nlm.nih.gov
^ seqchem.com

UpToDate Contents

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1. 多発性骨髄腫の治療プロトコル treatment protocols for multiple myeloma
2. 非移植候補患者における症候性多発性骨髄腫に対する初期化学療法 initial chemotherapy for symptomatic multiple myeloma in patients who are not candidates for transplantation
3. アミロイド心筋症の治療 treatment of amyloid cardiomyopathy
4. 抗腫瘍療法関連肺毒性：細胞傷害性薬物 pulmonary toxicity associated with antineoplastic therapy cytotoxic agents
5. 化学療法関連腎毒性および腎不全患者における用量調整 chemotherapy related nephrotoxicity and dose modification in patients with renal insufficiency

English Journal

Persistence of retinal function after intravitreal melphalan injection for retinoblastoma.

Brodie SE, Munier FL, Francis JH, Marr B, Gobin YP, Abramson DH.SourceDepartment of Ophthalmic Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, scott.brodie@mssm.edu.
Documenta ophthalmologica. Advances in ophthalmology.Doc Ophthalmol.2013 Feb;126(1):79-84. doi: 10.1007/s10633-012-9358-6. Epub 2012 Nov 11.
BACKGROUND: The risk/benefit profile of intravitreal melphalan injection for treatment of active vitreous seeds in retinoblastoma remains uncertain. We report clinical and electroretinography results after 6 months of one patient who has shown a favorable initial clinical response to intravitreal m
PMID 23143758

Age at menopause and its influencing factors in a cohort of survivors of childhood cancer: earlier but rarely premature.

Thomas-Teinturier C, El Fayech C, Oberlin O, Pacquement H, Haddy N, Labbé M, Veres C, Guibout C, Diallo I, De Vathaire F.SourceRadiation Epidemiology Group, Center for Research in Epidemiology and Population Health (CESP) - INSERM U1018, Villejuif F-94800, France.
Human reproduction (Oxford, England).Hum Reprod.2013 Feb;28(2):488-95. doi: 10.1093/humrep/des391. Epub 2012 Nov 15.
STUDY QUESTION: Is the age at menopause in a cohort of childhood cancer survivors earlier and what are the risk factors associated with earlier age at menopause SUMMARY ANSWER: Menopause occurred at a median age of 44 years in this cohort which is earlier than in the general population, but prem
PMID 23154067

Japanese Journal

胃と直腸に髄外性病変を認めた多発性骨髄腫の1例

望月洋介,齋藤康晴,稲富理,小泉祐介,馬場重樹,仲原民夫,辻川知之,石田光明,安藤朗,藤山佳秀
日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy 53(3), 1090-1096, 2011-03-20
症例は70歳代前半男性．腰痛を伴う高蛋白血症，高Ca血症，腎機能障害にて当院紹介受診．多発性骨髄腫と診断され化学療法にて寛解となるも，半年後に腹痛，腹満感が出現．腹部CTにて肝右葉に腫瘤を，また上部下部消化管内視鏡にて直腸および胃病変を認め，各々生検にて骨髄腫髄外病変と診断した．その後化学療法の反応乏しく，約5カ月後に死亡した．多発性骨髄腫の消化管髄外性病変は稀であり，本例では胃と直腸に認めたため …
NAID 10028053286

骨髄移植後にB型劇症肝炎を発症した急性骨髄性白血病の一例

菊池裕二,尾崎勝俊,松山智洋,岡智子,山本千鶴,森政樹,永井正,室井一男,小澤敬也
自治医科大学紀要 33, 111-116, 2011-03-01
悪性リンパ腫に対する自家末梢血幹細胞移植後に二次性白血病を発症した40歳男性に対し,非血縁男性ドナーから同種骨髄移植を行った。移植前,患者はHBsAg(-), HBsAb(-), HBcAb(-), HCVAb(+), HCV-RNA(+)であった。移植後より肝機能障害が遷延し,移植片対宿主病(graft-versus-host disease; GVHD)が疑われたためタクロリムス(tacrol …
NAID 110008506960

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リンク元	「メルファラン」「ナイトロジェンマスタード」「MP療法」「Alkeran」

「メルファラン」

Melphalan
Systematic (IUPAC) name
	4-[bis(chloroethyl)amino]phenylalanine
Clinical data
Trade names	Alkeran
AHFS/Drugs.com	monograph
MedlinePlus	a682220
Pregnancy cat.	?
Legal status	℞ Prescription only
Routes	Oral, intravenous
Pharmacokinetic data
Bioavailability	25% to 89%
Metabolism	hydrolysis
Half-life	1.5 ± 0.8 hours
Excretion	Renal, significantly metabolised
Identifiers
CAS number	148-82-3
ATC code	L01AA03
PubChem	CID 4053
DrugBank	DB01042
ChemSpider	405297
UNII	Q41OR9510P
KEGG	D00369
ChEBI	CHEBI:28876
ChEMBL	CHEMBL852
Synonyms	2-amino-3-[4-[bis(2-chloroethyl)amino]phenyl]-propanoic acid
Chemical data
Formula	C13H18Cl2N2O2
Mol. mass	305.2 g/mol
	SMILES c1cc(ccc1C[C@@H](C(=O)O)N)N(CCCl)CCCl;
	InChI InChI=1S/C13H18Cl2N2O2/c14-5-7-17(8-6-15)11-3-1-10(2-4-11)9-12(16)13(18)19/h1-4,12H,5-9,16H2,(H,18,19)/t12-/m0/s1 ; Key:SGDBTWWWUNNDEQ-LBPRGKRZSA-N ;
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