Evomela
Evomela (melphalan) is an anticancer treatment option that’s given before you receive a stem cell transplant for multiple myeloma. It’s given as an infusion through the vein by a healthcare provider. Evomela (melphalan) can be safely given at an infusion center or clinic. But in certain cases, you might have to stay in the hospital to receive your dose. In either case, your provider will check on you very often during the transplant recovery process.
What is Evomela (melphalan)?
What is Evomela (melphalan) used for?
Chemotherapy given before a stem cell transplant (conditioning regimen) for people with multiple myeloma
How Evomela (melphalan) works
Evomela (melphalan) is a type of anticancer medication called an alkylating agent. It works by damaging the cancer cells’ genetic material, leading to cell death.
Drug Facts
What are the side effects of Evomela (melphalan)?
Common Side Effects
- Diarrhea (93%)
- Nausea (90%)
- Fatigue (77%)
- Vomiting (64%)
- Low appetite (49%)
Other Side Effects
- Fever
- Dizziness
- Mouth ulcers or pain
- Change in taste
- Constipation
- Indigestion or heartburn
- Stomach pain
- Swelling of the arms or legs
Serious Side Effects
- Serious infections: repeated fevers, chills, cough, trouble breathing, severe diarrhea, vomiting, painful or frequent urination
- Serious bleeds: bleeding or bruising that doesn’t stop or go away, large amount of bleeding, blood in the urine, throwing up blood, bloody or black and tarry stool
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
chills
cough or hoarseness
lower back or side pain
painful or difficult urination
shortness of breath
sores, ulcers, or white spots on the lips or in the mouth
swollen glands
unusual bleeding or bruising
unusual tiredness or weakness
Incidence not known
Abdominal or stomach pain
absent, missed, or irregular menstrual periods
back or leg pains
bleeding gums
bloated abdomen or stomach
blurred vision
clay-colored stools
confusion
dark urine
difficult or labored breathing
difficulty with swallowing
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fast, pounding, or irregular heartbeat or pulse
general body swelling
headache
indigestion
light-colored stools
loss of appetite
noisy breathing
nosebleeds
pain and fullness in right upper abdomen or stomach
pale skin
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
reddening of the skin, especially around the ears
sweating
swelling of eyes, face, hands, ankles, feet, or lower legs
tightness in the chest
unpleasant breath odor
unusual lumps or masses
vomiting of blood
weight gain or loss
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
Blue-green to black skin discoloration
hair loss or thinning of the hair
pain, redness, soreness, or sloughing of the skin at the injection site
sores, welting, or blisters
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Evomela (melphalan)
Pros
Can usually be given in the outpatient setting (at an infusion center or clinic)
Recommended conditioning regimen before a transplant for people with multiple myeloma (considered standard of care)
Cons
Can raise your risk for infections, bleeding, or bruising
Common to have nausea, diarrhea, and mouth ulcers
Can affect your ability to have children in the future
Pharmacist tips for Evomela (melphalan)
Because Evomela (melphalan) can commonly cause nausea and vomiting, you’ll be prescribed anti-nausea medications to help with these side effects while you’re receiving Evomela (melphalan). Follow your provider’s instructions closely on how to take these medications. Let your provider know if your symptoms are worsening or not getting better.
Ask your provider about ways to prevent or treat mouth sores from Evomela (melphalan). Sometimes, chewing ice chips can help. Other options might include mouth rinses and nutrition support.
If you’re a woman who can get pregnant, you should use birth control while receiving Evomela (melphalan) and for 6 months after the last dose. This medication can cause harm to an unborn baby.
If you’re a man with a female partner who can get pregnant, you should use birth control measures, such as condoms, while you’re receiving Evomela (melphalan) and for 3 months after your last dose. It’s possible for Evomela (melphalan) to cause harm to the unborn baby of your female partner if you’re taking this medication.
Frequently asked questions about Evomela (melphalan)
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What are the risks and warnings for Evomela (melphalan)?
Evomela (melphalan) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood cell counts
Evomela (melphalan) can cause your red blood cell, white blood cell, and platelet counts to drop. Low blood cell counts can happen particularly with the high doses of this medication that’s required before a stem cell transplant. When the number of these cells are lower than normal, you’re at risk of developing anemia, infections, and bleeding or bruising. In some cases, your blood cell counts might be low for a while. This is because your chemotherapy medications can weaken your bone marrow and affect its ability to make new blood cells like normal.
To prevent serious problems, it’s absolutely necessary to receive a stem cell transplant shortly after receiving high doses of Evomela (melphalan). Your provider will closely check your blood counts through routine lab work after you receive this medication. They will continue to check your blood counts until they return to normal after your transplant. Let your provider know as soon as possible if you experience extreme tiredness, rapid breathing, fevers, chills, or bleeding and bruising that doesn’t stop or go away.
Allergic reactions
While rare, Evomela (melphalan) can cause allergic reactions, which can be serious. Contact your provider or get medical help right away if you experience any throat tightness, trouble breathing, hives or rashes, swelling of the arms or legs (edema), fast heartbeat, or dizziness.
Risk for developing other cancers
Although rare, it’s possible that you can develop other types of cancers, such as blood cancers (e.g., leukemias), when you take Evomela (melphalan). Talk to your provider if you’re concerned about your risk for other cancers.
Inflammation of the mouth and gut
Evomela (melphalan) can commonly cause nausea, vomiting, diarrhea, and painful mouth ulcers or sores. You’ll be given anti-nausea medication before your dose to help with some of these side effects. If you have mouth sores, let your provider know. They can prescribe mouthwashes and other treatments to help manage these symptoms.
Liver injury or damage
Evomela (melphalan) can sometimes cause liver injury. To check for liver problems, your provider will order blood tests regularly after your treatment with Evomela (melphalan) and for some time after transplant. Let your provider know right away if you experience right-side stomach pain, yellowing of the eyes or skin, dark urine, tiredness, nausea or vomiting, or loss of appetite. These can be signs of liver problems.
Harm to unborn baby and effects on fertility
Based on animal studies, Evomela (melphalan) can harm an unborn baby. Because of this risk, regardless of your sex, you should use birth control during treatment with Evomela (melphalan) to prevent pregnancy. After treatment, continue to use birth control for another 3 months (for males) or 6 months (for females). Let your provider know right away if you or your partner becomes pregnant during this time.
Evomela (melphalan) might also affect your ability to have a baby. If you or your partner are thinking about having a child in the future, talk to your provider about your different options before starting Evomela (melphalan), such as sperm banking or egg freezing.
Evomela (melphalan) dosage forms
Typical dosing for Evomela (melphalan)
This medication is an injection into a vein (intravenous, IV) that’s given by a healthcare provider. Your provider will calculate your dose of Evomela (melphalan) using your body surface area (BSA, in units of m2), which takes into account your body weight and height.
Your dosing regimen will depend on your treatment center’s specific protocol for conditioning with Evomela (melphalan). One possible dosing regimen is 100 mg/m2 per day for two days in a row before a stem cell transplant. For this particular regimen, your course of Evomela (melphalan) will begin 3 days before your transplant (on days -3 and -2, with day 0 as the day you’ll receive a transplant).
Interactions between Evomela (melphalan) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rotavirus Vaccine, Live
- Rubella Virus Vaccine, Live
- Varicella Virus Vaccine, Live
- Zoster Vaccine, Live
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine
- Bacillus of Calmette and Guerin Vaccine, Live
- Cholera Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Influenza Virus Vaccine, Live
- Poliovirus Vaccine, Live
- Smallpox Vaccine
- Typhoid Vaccine, Live
- Yellow Fever Vaccine
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Buthionine Sulfoximine
- Nalidixic Acid
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References
Best studies we foundAcrotech Biopharma Inc. (2023). Evomela- melphalan injection, powder, lyophilized, for solution [package insert]. DailyMed.
Ali, M. O., et al. (2022). High dose (conditioning) regimens used prior to autologous stem cell transplantation in multiple myeloma. Transplantation and Cellular Therapy.
American Cancer Society. (n.d.). Stem cell or bone marrow transplant.
American Cancer Society. (2018). What is multiple myeloma?
American Cancer Society. (2020). Getting a stem cell or bone marrow transplant.
American Cancer Society. (2020). Low platelet count (bleeding).
American Cancer Society. (2020). Preserving fertility in males with cancer.
American Cancer Society. (2023). Low red blood cell counts (anemia).
American Cancer Society. (2023). Low white blood cell counts (neutropenia).
American Society of Hematology. (n.d.). Blood cancers.
Bell, A., et al. (2023). Oral mucositis. StatPearls.
Brown, T. J., et al. (2020). Management of cancer therapy-associated oral mucositis. JCO Oncology Practice.
Centers for Disease Control and Prevention. (2023). Oral health tips.
Flint, B., et al. (2023). Body surface area. StatPearls.
InformedHealth.org. (2016). Causes and signs of edema. Institute for Quality and Efficiency in Health Care.
National Cancer Institute. (n.d.). Alkylating agent.
National Cancer Institute. (n.d.). Conditioning regimen.
National Center for Chronic Disease Prevention and Health Promotion. (n.d.). What you need to know: Neutropenia and risk for infection.
Tartarone, A., et al. (2004). Prevention of high dose melphalan-induced mucositis by cryotherapy in transplanted patients. Journal of Clinical Oncology.
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