The dose of an alkeran (melphalan hydrochloride) infusion should be reduced if concurrent renal and hematologic disorders are identified. This can help reduce the likelihood of severe bone marrow suppression.
Standard intravenous dose: 16 mg per square meter BSA
This dose is reduced in the presence of either:
(1) renal insufficiency
(2) bone marrow toxicity
If there is evidence of renal insufficiency (BUN >= 30 mg/dL), then the dose should be decreased by 50%. This reduces the risk of severe leukopenia.
WBC Count per µL
Platelet Count per µL
Dose as Percent of Usual
>= 4,000
>= 100,000
100%
3,000 to 3,999
75,000 to 99,999
75%
2,000 to 2,999
50,000 to 74,999
50%
< 2,000
< 50,000
0%
where:
• I assume the adjustment for bone marrow suppression is based on which lineage (myeloid vs megakaryocytic) shows the greater suppression.
• The WBC and platelet counts are measured during the nadir following therapy and before the next dose. I would assume that the adjustment is based on the counts measured just before the next dose.
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