Optimizing high dose melphalan Review

  


Authors: Shah, G.; Giralt, S.; Dahi, P.
Review Title: Optimizing high dose melphalan
Abstract: Melphalan, has been a major component of myeloma therapy since the 1950s. In the context of hematopoietic cell transplantation (HCT), high dose melphalan (HDM) is the most common conditioning regimen used due to its potent anti-myeloma effects and manageable toxicities. Common toxicities associated with HDM include myelosuppression, gastrointestinal issues, and mucositis. Established approaches to reduce these toxicities encompass dose modification, nausea prophylaxis with 5HT3 receptor antagonists, cryotherapy, amifostine use, and growth factors. Optimization of melphalan exposure through personalized dosing and its combination with other agents like busulfan, or bendamustine show promise. Propylene glycol-free melphalan (Evomela) represents a novel formulation aiming to enhance drug stability and reduce adverse effects. This review explores strategies to enhance the efficacy and mitigate the toxicity of HDM in multiple myeloma. Future directions involve exploring these strategies in clinical trials to improve the safety and efficacy of HDM, thereby enhancing outcomes for multiple myeloma patients undergoing autologous HCT. © 2023 Elsevier Ltd
Keywords: busulfan; fatigue; review; dose response; drug efficacy; drug safety; drug megadose; proteasome inhibitor; multiple myeloma; bone marrow suppression; gastrointestinal symptom; mucosa inflammation; bendamustine; melphalan; autologous stem cell transplantation; hematopoietic stem cell transplantation; febrile neutropenia; pneumonia; hematologic malignancy; transplantation conditioning; interleukin 6; sepsis; music therapy; acupuncture; growth factor; transplantation, autologous; drug stability; amifostine; myeloma; oral mucositis; drug formulation; serotonin 3 antagonist; personalized medicine; cryotherapy; autotransplantation; illumination; phototherapy; high dose therapy; symptom burden; humans; human; mentoring; bendamustine hydrochloride; chemotherapy induced nausea
Journal Title: Blood Reviews
Volume: 64
ISSN: 0268-960X
Publisher: Churchill Livingstone  
Date Published: 2024-03-01
Start Page: 101162
Language: English
DOI: 10.1016/j.blre.2023.101162
PUBMED: 38097487
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85180471149&doi=10.1016%2fj.blre.2023.101162&partnerID=40&md5=55c73de47ff84bebb144a2899095a3e5
Notes: Review -- Source: Scopus
Altmetric
What is Altmetric?
Citation Impact
What is Dimensions Citation Badge?
BMJ Impact Analytics
MSK Authors
  1. Sergio Andres Giralt
    1050 Giralt
  2. Parastoo Bahrami Dahi
    294 Dahi
  3. Gunjan Lalitchandra Shah
    418 Shah
Related MSK Work