Melphalan: What It Is, How It Works, and What You Need to Know

When you hear Melphalan, a chemotherapy drug used to treat multiple myeloma and certain types of lymphoma. Also known as L-PAM, it's one of the older but still widely used alkylating agents in oncology. Unlike newer targeted therapies, Melphalan doesn’t pick and choose cancer cells—it damages DNA across the board, which is why it’s powerful but also tough on the body.

It’s most commonly used for multiple myeloma, often before a stem cell transplant, or as maintenance therapy after treatment. It can be given orally as a pill or intravenously, depending on the treatment plan. Melphalan works by attaching itself to DNA strands in rapidly dividing cells, causing breaks and errors that stop cancer cells from multiplying. But because it doesn’t distinguish between cancer cells and healthy ones—like those in your bone marrow, gut, or hair follicles—it causes side effects you can’t ignore: low blood counts, nausea, hair loss, and increased infection risk.

What makes Melphalan different from other chemo drugs is how it’s used in high-dose settings. In transplant protocols, doctors push the dose to the limit, knowing the body will need a reset with stem cells afterward. This isn’t casual treatment—it’s a calculated risk, and patients need close monitoring. Blood tests aren’t optional; they’re routine. If your white blood cell count drops too low, treatment pauses. If your kidneys aren’t clearing the drug properly, the dose gets adjusted. It’s not just about killing cancer—it’s about keeping you alive through the process.

People often ask if Melphalan is outdated. It’s not. While newer drugs like lenalidomide or bortezomib have changed the landscape, Melphalan remains a backbone in many treatment regimens because it’s effective, predictable, and affordable. It’s also used in rare cases for ovarian cancer, melanoma, and amyloidosis. The key isn’t whether it’s old—it’s whether it still works for your situation.

Side effects are real, but they’re manageable. Anti-nausea meds help. Growth factors can boost blood counts. Hydration protects your kidneys. And while hair loss happens, it’s usually temporary. The bigger challenge is emotional—facing chemo, even when you know it’s necessary, is heavy. That’s why so many patients find comfort in tracking symptoms, asking questions early, and knowing when to speak up about fatigue, fever, or unusual bruising.

Below, you’ll find real patient-focused articles that dig into what Melphalan really means in practice: how it fits into broader cancer care, how to handle its side effects, what to expect during treatment, and how it compares to other options. These aren’t just clinical summaries—they’re guides written for people living through this, not just reading about it.