ALKYLATING AGENTS
Alkylators are chemotherapy drugs that interfere with the DNA replication process, causing cell death as a result. Alkylators were the earliest effective drugs used in the treatment of patients with myeloma. The alkylators listed below in alphabetical order are still used in myeloma.
Bendamustine
Bendamustine is the generic name of a drug that is available globally under several brand names. It is both an alkylator and a purine analog, a compound that emulates the fundamental building blocks of DNA. When DNA incorporates a purine analog, the replication process is hindered, leading to the death of cancer cells. Bendamustine clinical trials have demonstrated its efficacy throughout the myeloma disease course, especially when combined with other drugs. Bendamustine is recognized by the National Comprehensive Cancer Network (NCCN). Please note that bendamustine may affect the ability to collect T cells prior to CAR T-cell therapy.
Cyclophosphamide
Cyclophosphamide is the generic name of a drug that is available globally under several brand names. Cyclophosphamide was first approved by the U.S. Food and Drug Administration (FDA) in 1959 and it is still used in combination with other drugs to treat myeloma throughout the disease course. Cyclophosphamide is also used to help with stem cell collection prior to autologous stem cell transplantation (ASCT). Use of cyclophosphamide may slightly increase the risk of developing myelodysplasia or leukemia.
Melphalan
Melphalan is the generic name of a drug that is available globally under several brand names. Melphalan was first synthesized in 1953 and first used to treat myeloma in 1962. In the U.S., melphalan is used as a conditioning therapy prior to ASCT. It is given at a high dose to kill myeloma cells within the bone marrow before the patient’s own
blood-making stem cells are re-infused to restore bone marrow function. Melphalan used at lower doses as part of combination therapy is well tolerated, even by older and frail patients.
Common side effects of alkylators
Alkylating agents are not strictly selective for cancer cells Normal cells that divide rapidly are also affected. This is why some patients experience hair loss. Other side effects may include the following:
Gastrointestinal (GI) side effects
Alkylators may cause nausea or vomiting.
Bone marrow suppression
Alkylators may cause low levels of red blood cells (anemia), white blood cells (neutropenia or risk for infection), and platelets (thrombocytopenia or risk for bleeding).
Gonadal dysfunction
Alkylators may affect sexual function or fertility.
Secondary malignancies
Alkylators may increase the risk of new cancers.
Alkylators are given intermittently in order to give patients time to recover from their prior exposure. Before starting treatment with alkylators, ask your doctor what to expect during treatment and how side effects may be prevented, minimized, or managed.
Use the QR code below or visit medications.myeloma.org for more information.
As always, the IMF urges you to discuss all medical issues with your doctor and to contact the IMF InfoLine with your myeloma-related questions and concerns at 1.818.487.7455 or infoline@myeloma.org.
4400 Coldwater Canyon Avenue #300 – Studio City, CA 91604 1.818.487.7455 TheIMF@myeloma.org myeloma.org