melphalan and Drug-Hypersensitivity

All cancer chemotherapeutic agents, except altretamine, the nitrosoureas, and dactinomycin, have produced at least an isolated instance of a HSR. Certain drugs, such as L-asparaginase and mitomycin (administered intravesically), cause HSRs of significant degree in approximately 10% of patients. All four types of HSRs are represented in the reactions produced by antitumor drugs, although Type I is the most common. Some of the Type I reactions are IgE-mediated, and others are probably mediated by nonspecific release of vasoactive substances from targets such as mast cells. It is possible to continue therapy with some drugs, despite a prior HSR, if the prophylactic measures outlined in Table 2 are taken. An example of this is provided by taxol in which the lengthening of the infusion time and the administration of preventive medication allowed some patients to continue taxol therapy. The mechanisms of the HSRs have been carefully assessed in only a minority of patients who sustained such toxicity. Such evaluation would increase our understanding of this form of drug toxicity and perhaps lead to means of effectively reducing the risk and severity.

Topics: Antibiotics, Antineoplastic; Antineoplastic Agents; Asparaginase; Aziridines; Benzoquinones; Bleomycin; Chlorambucil; Cisplatin; Cyclophosphamide; Cytarabine; Dacarbazine; Drug Hypersensitivity; Etoposide; Fluorouracil; Humans; Ifosfamide; Melphalan; Methotrexate; Mitomycins; Neoplasms; Paclitaxel; Pentostatin; Procarbazine; Teniposide

A case of acute interstitial pneumonia with hypoxaemia is described; this occurred after the cessation of cortico steroids in a patient suffering from myeloma treated with melphalan. The absence of any microbes and the lymphocytosis in the bronchoalveolar lavage and the rapid and favourable improvement on cortico steroids led to a diagnosis of melphalan induced pneumonia. This acute form is probably due to a hypersensitivity mechanism and should be distinguished from the majority of cases of sub-acute fibrosing pneumonitis due to melphalan which have been published before. Urgent treatment with glucocorticoids is justified as well as the immediate and final cessation of the medication responsible, because it is this which will affect prognosis.

Topics: Acute Disease; Aged; Aged, 80 and over; Drug Hypersensitivity; Female; Humans; Melphalan; Pulmonary Fibrosis; Radiography

Four intravenous (IV) alkylating agent regimens were tested in 615 previously untreated patients with multiple myeloma. Patients were randomized to receive melphalan, cyclophosphamide, and carmustine in combination (MCBP), sequentially (Seq-MCBP), or in combination with doxorubicin (MCBPA). The fourth group received IV melphalan (MP) as the only alkylating agent. All groups received a tapering dose of prednisone. Toxicity was similar for all regimens although the nadir of cytopenia was reached more quickly for the regime including melphalan only. Response as measured by reduction in myeloma protein or other parameters were similar for the four treatments. Survival was significantly poorer for the group receiving the alkylating agents in sequence. The survival of high tumor cell load patients who were azotemic was better in the groups treated with IV MP or with the combination of IV MCBP. In view of the simplicity and probable cost savings attached to single-agent treatment, a melphalan/prednisone regimen should be considered as initial therapy for all patients with myeloma.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Clinical Trials as Topic; Cyclophosphamide; Doxorubicin; Drug Hypersensitivity; Female; Humans; Leukocyte Count; Male; Melphalan; Middle Aged; Multiple Myeloma; Myeloma Proteins; Platelet Count

Ten patients developed allergic reactions to iv melphalan (L-PAM) during therapy for multiple myeloma. The incidence of such reactions was 2.4% among 425 patients receiving iv L-PAM with or without other drugs and 3.9% among 255 patients receiving iv L-PAM alone. Only one such reaction was demonstrated in 294 patients who initially received oral L-PAM. The median day of first reaction to iv L-PAM was Day 222 (range, Days 44-909) and the median total dose prior to a reaction was 185 mg (range, 51-250 mg). Of five patients who subsequently received oral L-PAM, four developed a reaction similar to that experienced with the iv drug.

Topics: Administration, Oral; Aged; Drug Hypersensitivity; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Male; Melphalan; Middle Aged; Multiple Myeloma

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Boronic Acids; Bortezomib; Cyclosporine; Dexamethasone; Drug Hypersensitivity; Exanthema Subitum; Herpesvirus 3, Human; Herpesvirus 6, Human; Humans; Male; Melphalan; Middle Aged; Multiple Myeloma; Neoplasm Recurrence, Local; Prednisone; Pyrazines; Syndrome; Virus Activation

Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Carmustine; Cytarabine; Drug Hypersensitivity; Female; Fibroblast Growth Factor 7; Foot Dermatoses; Hand Dermatoses; Humans; Lymphoma, B-Cell; Melphalan; Middle Aged; Mitogens; Podophyllotoxin

To determine the influence of acute regional toxic reactions on the incidence and characteristics of long-term morbidity after regional isolated perfusion with melphalan.. Retrospective study.. The Amsterdam and Rotterdam perfusion centers, the Netherlands.. All patients with melanoma who were treated between 1978 and 1990 and had a minimum follow-up of 1 year after perfusion (n = 367).. Fifty-four patients (15%) had perfusion of the upper limb, 313 (85%) had perfusion of the lower limb, and 164 patients (45%) underwent regional lymph node dissection at the time of perfusion.. Incidence and characteristics of morbidity 1 year after perfusion and the influence of acute regional toxic reactions on long-term morbidity.. One hundred sixty patients (44%) showed some degree of objective or subjective morbidity; most (104 [28%]) had lymphedema. Other long-term morbidity consisted of muscle atrophy or fibrosis (42 [11%]), limb malfunction (55 [15%]), neuropathy (13 [4%]), pain (28 [8%]), and recurrent infection (11 [3%]). Miscellaneous complications were seen in 14 patients (4%). Seventy-one patients (19%) had more than one complication. Acute regional toxic reactions had a statistically significant effect on the incidence of long-term morbidity (P < .01). Moderate to severe acute regional toxic reactions were strongly linked to the occurrence of muscle atrophy or fibrosis (P < .001) and limb malfunction (P < .001). Regional lymph node dissection was statistically significantly related to lymphedema (P = .05).. Improvement of the perfusion technique should be pursued in an effort to reduce acute regional toxic reactions, and thereby long-term morbidity, without compromising the therapeutic effect.

Topics: Adult; Aged; Aged, 80 and over; Chemotherapy, Cancer, Regional Perfusion; Drug Hypersensitivity; Extremities; Female; Humans; Lymphedema; Male; Melanoma; Melphalan; Middle Aged; Morbidity; Muscular Atrophy; Skin Neoplasms

The most common side effects of melphalan administration include nausea, vomiting, and bone marrow suppression. Less well known is the fact that allergic reactions can become evident after both intravenous and oral melphalan administration. In the present study we report a patient with a plasmocytoma, who developed an allergic reaction with melphalan intravenously, but tolerated melphalan orally.

Topics: Drug Hypersensitivity; Drug Therapy, Combination; Humans; Immunoglobulin A; Immunoglobulin E; Immunoglobulin M; Male; Melphalan; Middle Aged; Plasmacytoma; Vincristine

Topics: Aged; Cyclophosphamide; Drug Hypersensitivity; Humans; Male; Melphalan

Topics: Animals; Basophils; Drug Hypersensitivity; Freund's Adjuvant; Immunization; Melphalan; Rabbits; Time Factors

Topics: Chemotherapy, Cancer, Regional Perfusion; Coccidioidomycosis; Dactinomycin; Drug Hypersensitivity; Drug Therapy; Hematologic Diseases; Humans; Melanoma; Melphalan; Mycetoma; Neoplasms; Sarcoma; Sepsis; Toxicology