Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
MELPPRED
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
First line treatment of patients with multiple myeloma who are not candidates for transplant.
melphalan
ODB - General Benefit
(melphalan - oral tablets)
prednisone
ODB - General Benefit
(prednisone)
| melphalan | 8-9 mg /m² | PO | Days 1 to 4 |
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(Outpatient prescription in multiples of 2mg tablets; taken on an empty stomach, for maximal absorption)
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| prednisone | 100 mg | PO | Days 1 to 4 |
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(Outpatient prescription in multiples of 50mg tablets)
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Minimal – No routine prophylaxis; PRN recommended
Other Supportive Care:
Also refer to CCO Antiemetic Recommendations.
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
See Appendix 6 for general recommendations.
Renal Impairment
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Creatinine Clearance (mL/sec)
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% usual dose
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0.2 – 0.8
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REDUCE Melphalan to 75% dose
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<0.2
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REDUCE Melphalan to 50% dose
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Refer to melphalan, prednisone drug monograph(s) for additional details of adverse effects
Most frequently occurring adverse effects
- Myelosuppression
- Stomatitis
- Pulmonary toxicity
- Hyperglycemia
- Insomnia
- Mood changes
- Cushingoid syndrome
- Muscle weakness
- Gastric irritation – peptic ulcer
- Fluid retention
- Cataracts
Refer to melphalan, prednisone drug monograph(s) for additional details
Recommended Clinical Monitoring
- Clinical toxicity assessment (including stomatitis, gastrointestinal)
- Routine blood glucose test.
- Routine CBC (since absorption of melphalan is erratic, mild myelosuppression should be detected three weeks after drug administration, in order to confirm drug absorption).
- Baseline and regular hepatic and renal function tests and urinalysis.
- Routine pulmonary function test and clinical pulmonary exam.
- Clinical exam for proximal muscle myopathy.
- Baseline ophthalmologic exam for evidence of cataracts.
- Full assessment by ophthalmologist if cataracts suspected.
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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Bataille R, Harousseau JL. Multiple myeloma. N Engl J Med 1997;336:1657-64.
Bergsagel DE, Sprague CC, Austin C et al. Evaluation of new chemotherapeutic agents in the treatment of myeloma IV: phenylalaine mustard. Cancer Chemothera Rep 1962; 21:87.
Gregory WM, Richards MA, Malpas JS. Combination chemotherapy versus melphalan & prednisolone in the treatment of multiple myeloma: An overview of published trials. J Clin Oncol 1992;10:334-42.
Myeloma Trialists’ Collaborative Group. Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6633 patients from 27 randomized trials. J Clin Oncol 1998;16:3832-42.
June 2019 Updated emetic risk category; added PEBC guideline link
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
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