Name of the Procedure:

• Common Name: Injection of melphalan
• Medical Term: Injection, melphalan hydrochloride, 50 mg (HCPCS Code: J9245)

Summary

Melphalan hydrochloride injection is a treatment involving the administration of a chemotherapy drug directly into the bloodstream. This procedure is primarily used to treat certain types of cancer by targeting and destroying cancerous cells.

Purpose

The primary purpose of a melphalan hydrochloride injection is to treat cancers such as multiple myeloma and ovarian cancer. The goal is to reduce or eliminate cancerous cells, slow the progression of the disease, and potentially achieve remission.

Indications

• Multiple myeloma
• Ovarian cancer
• Conditions warranting high-dose chemotherapy, like in preparation for a stem cell transplant

Patient criteria:

• Diagnosed with one of the indicated cancers
• Evaluated and deemed appropriate for chemotherapy
• Adequate organ function to tolerate chemotherapy

Preparation

• Patients may need to fast for several hours before the procedure.
• Blood tests and diagnostic scans to confirm the suitability for chemotherapy.
• Adjustment of current medications as directed by the healthcare provider.
• Hydration may be emphasized to minimize kidney complications.

Procedure Description

1. Patient check-in and vital signs assessment.
2. Placement of an intravenous (IV) line or use of an existing central venous catheter.
3. Premedications might be administered to reduce side effects.
4. Slow infusion of melphalan hydrochloride over a specified period, typically 15-30 minutes.
5. Monitoring of the patient throughout the infusion for any adverse reactions.

Tools and Equipment:

• IV line or central venous catheter
• Infusion pump
• Premedications and melphalan hydrochloride solution

Anesthesia or Sedation:

• Generally, no anesthesia or sedation is required, but anti-nausea medications and other supportive measures might be used.

Duration

The infusion of melphalan hydrochloride typically takes around 15-30 minutes.

Setting

The procedure is usually performed in an outpatient setting at a hospital or specialty clinic.

Personnel

• Oncologist or hematologist
• Oncology nurse
• Pharmacist (for preparation of the chemotherapy drug)
• Additional nursing staff as necessary

Risks and Complications

Common risks:

• Nausea and vomiting
• Fatigue
• Hair loss
• Suppressed immune system leading to increased risk of infections

Rare risks:

• Severe allergic reactions
• Kidney or liver damage
• Secondary cancers

Complications are managed with medications, supportive care, and close monitoring.

Benefits

The expected benefit is the reduction or elimination of cancerous cells, potentially leading to remission or a significant slowing of disease progression. Improvements are typically seen after several cycles of treatment.

Recovery

Post-injection care includes:

• Hydration and rest
• Management of side effects with prescribed medications
• Follow-up appointments for blood tests and monitoring
• Patients may experience fatigue and should plan for limited activity during recovery.
• Adequate nutrition and hydration are emphasized.
• Recovery can vary, but most patients feel overall improvement within a few weeks to months.

Alternatives

Alternative treatments include:

• Surgery (if applicable depending on cancer type and stage)
• Other chemotherapy agents
• Radiation therapy
• Targeted therapy
• Immunotherapy

Pros and cons:

• Surgery can provide immediate removal of tumors but may require long recovery and isn't always feasible.
• Other treatments vary in effectiveness and side effects compared to melphalan.

Patient Experience

During the procedure, patients may feel a cold sensation from the infusion but should not experience pain. After the procedure, patients can expect varying degrees of fatigue and potential side effects like nausea, which can be managed with medication. Support from healthcare providers is available to ensure comfort and manage any adverse reactions.