Malignant melanoma, Soft tissue sarcoma
Adult: As melphalan hydrochloride: Upper extremity perfusions: 0.6-1 mg/kg. Lower extremity perfusions: 0.8-1.5 mg/kg (in melanoma) or 1-1.4 mg/kg (in sarcoma).
Elderly: Initiate treatment at the lower end of the dosing range.
Elderly: Initiate treatment at the lower end of the dosing range.
Intravenous
Multiple myeloma
Adult: As melphalan hydrochloride: 0.4 mg/kg (16 mg/m2) repeated at appropriate intervals (e.g. once every 4 weeks) provided there has been recovery of the peripheral blood count during this period. As high-dose regimen: 100-200 mg/m2, to be followed by haematopoietic stem cell rescue if doses are >140 mg/m2. As melphalan flufenamide: In patients with relapsed or refractory multiple myeloma who have received ≥4 prior lines of therapy and whose disease is refractory to ≥1 proteasome inhibitor, 1 immunomodulatory agent, and 1 CD38-directed monoclonal antibody: 40 mg over 30 minutes on Day 1 of each 28-day treatment cycle, in combination with dexamethasone. Continue until disease progression or unacceptable toxicity. Dose reduction or modifications may be required according to individual safety or tolerability (refer to detailed product guideline).
Elderly: Initiate treatment at the lower end of the dosing range.
Elderly: Initiate treatment at the lower end of the dosing range.
Intravenous
Ovarian adenocarcinoma
Adult: As melphalan hydrochloride: Monotherapy: 1 mg/kg (approx 40 mg/m2) given at intervals of 4 weeks. In combination with other cytotoxic drugs: 0.3-0.4 mg/kg (12-16 mg/m2) at intervals of 4-6 weeks.
Elderly: Initiate treatment at the lower end of the dosing range.
Elderly: Initiate treatment at the lower end of the dosing range.
Intravenous
Advanced neuroblastoma
Child: As melphalan hydrochloride: High-dose regimen: 100-240 mg/m2 (may be divided equally over 3 consecutive days) followed by haematopoietic stem cell rescue if doses are >140 mg/m2.
Oral
Ovarian adenocarcinoma
Adult: 0.2 mg/kg daily for 5 days, repeated every 4-8 weeks, or as soon as the bone marrow has recovered.
Elderly: Initiate treatment at the lower end of the dosing range.
Elderly: Initiate treatment at the lower end of the dosing range.
Oral
Breast cancer
Adult: 0.15 mg/kg or 6 mg/m2 daily for 5 days, repeated every 6 weeks. Dose reduction may be needed if bone marrow toxicity was observed.
Elderly: Initiate treatment at the lower end of the dosing range.
Elderly: Initiate treatment at the lower end of the dosing range.
Oral
Polycythemia vera
Adult: Remission induction: 6-10 mg daily for 5-7 days, then 2-4 mg daily until satisfactory disease control is achieved. Maintenance: 2-6 mg once weekly, with careful haematological control and dosage adjustment based on blood counts.
Elderly: Initiate treatment at the lower end of the dosing range.
Elderly: Initiate treatment at the lower end of the dosing range.
Oral
Multiple myeloma
Adult: Usual dosage regimens: Regimen 1: 0.15 mg/kg daily in divided doses for 4 days, repeated at 6-week intervals, usually in combination with a corticosteroid. Regimen 2: 6 mg once daily for 2-3 weeks, followed by up to 4 weeks rest with careful monitoring of blood counts. A maintenance dose of 2 mg daily may be given if WBC and platelet counts are rising. Several regimens have been used; refer to detailed product-specific guidelines. Delay or adjust dose if necessary. Dosage may need to be cautiously increased until myelosuppression is observed, to ensure that potentially therapeutic levels have been reached.
Elderly: Initiate treatment at the lower end of the dosing range.
Elderly: Initiate treatment at the lower end of the dosing range.