Melphalan

Decrease in white blood cell count

• This may increase your chances of getting an infection.

• To reduce the risk of infections:
  • Maintain good hand hygiene. Wash your hands before handling food and after using the toilet.
  • Avoid crowds and do not go near people who are sick. Wear a mask if necessary.
• Eat freshly cooked and well-cooked food. Avoid raw meats, vegetables and eggs, or half-cooked or uncooked food.
• Proceed to the A&E department immediately if you have any signs of infection, such as having
  • A fever of 38°C and above
  • Chills
  • Bad sore throat
  • Pain when you pass urine
  • Mouth sores or wounds that do not heal
• You should avoid taking Paracetamol to relieve fever as this may mask your fever and delay the treatment of your infection.

Decrease in platelet count 

• Low platelet levels can increase your chance of bleeding

• To reduce the risk of bleeding:
  • Be careful when using sharp objects such as scissors or knives.
  • Brush your teeth gently with a soft bristle toothbrush to prevent gum bleeding.
• Try not to bruise, cut, or knock yourself. Apply direct pressure to any cuts or wounds to help stop bleeding.
• Proceed to the A&E department immediately if you have symptoms of serious bleeding including:
  • Blood in the urine
  • Black, sticky or bloody stools
  • Unexplained large bruises
  • Coughing up blood or coffee ground-like vomit
  • Bleeding that does not stop

Decrease in the number of red blood cells (anaemia)

• This means there are less red blood cells in your body to carry oxygen to your organs and tissues.
• Symptoms may include worsening tiredness, pale skin or lips, feeling breathless more easily, or having a fast heartbeat while resting.

• Proceed to the A&E department immediately if you have:
  • Unusual giddiness or light-headedness that does not go away
  • Severe breathlessness or rapid breathing
• An unusually fast heartbeat while resting

• Take small and frequent meals.
• Avoid foods or smells that may make you feel nauseous, such as oily, fried, or strong-smelling food.
• Avoid tight-fitting clothes around the waist.
• Your doctor may prescribe medications to help relieve or prevent nausea or vomiting. Take these as instructed.

Mouth ulcers or sores

• This can occur on the tongue, the sides of the mouth or in the throat and can lead to an infection.

• Rinse your mouth regularly with an alcohol-free mouthwash or salt water to help reduce the  chances of infection.
• Brush your teeth gently after eating and at bedtime with a soft bristle toothbrush.
• Rinse and brush your dentures after eating and soak them in denture solution overnight.
• Avoid spicy food and take soft foods e.g. porridge.
• Your doctor may prescribe medications to help relieve or prevent the mouth sores. Use these as instructed.
• Inform your doctor if you are eating or drinking a lot less because of mouth pain.

• Consider cutting your hair short before chemotherapy, using wigs or head coverings like hats or scarves.

• Use a mild shampoo (such as baby shampoo) to wash your hair and scalp.

• Your hair will grow back a few weeks after chemotherapy is completed.

Hypersensitivity (allergic) reaction 

• Allergies are usually uncommon.
• This is usually mild or moderate, but rarely can be more severe.

• Inform the nurse immediately if you experience any of the following during the infusion:
  • Flu-like symptoms such as fever, chills or dizziness, feeling warm or flushed
  • Red, warm, and itchy bumps on the skin
  • Swelling of the lips, tongue or throat
  • Breathlessness, wheezing, cough or sudden difficulty breathing
  • Back pain or chest pain
• If you do have a reaction, this is usually treated by slowing or stopping the drip until the reaction is over. You may also be given medications to help with the symptoms. Future infusions may also be given at a slower rate.

Liver problems

• Rarely, this medication can injure or damage the liver. A liver injury may recover on its own. However, in some cases, it can cause serious liver damage.

• Stop this medication and proceed to the A&E department immediately if you experience any:
  • Dark coloured urine
  • Llight-coloured stools
  • Yellowing of your skin or eyes
  • Nausea, vomiting that does not go away
  • Severe abdominal pain

• Proceed to the A&E department immediately if you have any new or worsening symptoms of lung problems such as shortness of breath, cough, or chest pain.