Care During Chemotherapy and Beyond
Trade name: Alkeran ®
Other names: L-Sarcolysin, Phenylalanine Mustard
Drug type: L-PAM is an anti-cancer ("antineoplastic" or "cytotoxic")
chemotherapy drug. L-PAM is classified as an "alkylating agent." (For
more detail, see "How this drug works" section below).
What L-PAM Is Used For:
- Multiple myeloma
- Ovarian cancer
- Breast cancer
- Used in some conditioning regimens prior to bone marrow transplant
Note: If a drug has been approved for one use, physicians
may elect to use this same drug for other problems if they believe it may be helpful.
How L-PAM Is Given:
- As a pill by mouth. Tablets come in a 2mg size.
- Take medication on an empty stomach (1 hour before to 2 hours after meals).
- As an injection or infusion into the vein (intravenous, IV).
- The amount of L-PAM that you will receive depends on many factors, including your
height and weight, your general health or other health problems, and the type of
cancer or condition being treated. Your doctor will determine your dose and
Important things to remember about the side effects of L-PAM:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
- The side effects of L-PAM and their severity depend on how much of the drug is given.
In other words, high doses may produce more severe side effects).
The following side effects are common (occurring in greater than 30%) for
patients taking L-PAM:
- Low blood counts. Your white and red blood cells and platelets may temporarily
decrease. This can put you at increased risk for infection, anemia and/or
bleeding. This effect may be prolonged and cumulative.
- Nausea and vomiting. (mild with regular dosing, can be severe with high-dose therapy)
These side effects are less common side effects (occurring in about 10-29%)
of patients receiving L-PAM:
- Allergic reaction (rare with pill form, happen in about 10% of patients treated
with IV form).
- Mouth sores (mild with regular dosing, can be severe with high-dose therapy).
- Diarrhea (mild with regular dosing, can be severe with high-dose therapy).
- Loss of fertility. Meaning, your ability to conceive or father a child may
be affected by L-PAM.Discuss this issue with your health care provider.
- Hair loss (rare with regular dosing, common with high-dose used for bone marrow
- Nephrotoxicity (see kidney problems): Uncommon with regular doses, seen when L-PAM
is given in high-doses used for bone marrow transplant.
- Arrythmias (see heart problems): Uncommon with regular doses, seen when L-PAM is
given in high-doses used for bone marrow transplant.
- There is a slight risk of developing a blood cancer such as leukemia or myelodysplasia
after taking L-PAM. Talk to your doctor about this risk.
Nadir: Meaning low point, nadir is the point in time
between chemotherapy cycles in which you experience low blood counts.
Onset: 7 days
Nadir: 8-10 days (white blood cells), 27-32 days (platelets).
Recovery: 42-50 days
Not all side effects are listed above. Some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor or health care provider:
Seek emergency help immediately and notify your health care provider,
it you experience the following symptoms:
- Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling
of facial features, hives (possible allergic reaction).
Contact your health care provider immediately, day or night, if you
should experience any of the following symptoms:
- Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours of noticing any of the
- Nausea (interferes with ability to eat and unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Diarrhea (4-6 episodes in a 24-hour period)
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools or urine
- Extreme fatigue (unable to carry on self-care activities)
- Mouth sores (painful redness, swelling or ulcers)
- Yellowing of the skin or eyes. Signs of infection such as redness or swelling, pain
on swallowing, coughing up mucous, or painful urination.
Always inform your health care provider if you experience any unusual symptoms.
- Before starting L-PAM treatment, make sure you tell your doctor about any other
medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless
your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking L-PAM.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (L-PAM may be hazardous to
the fetus. Women who are pregnant or become pregnant must be advised of the
potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking L-PAM.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- If taking L-PAM pills take on an empty stomach 1 hour before or 2 hours after meals.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- You may be at risk of infection so try to avoid crowds or people with colds and
those not feeling well, and report fever or any other signs of infection immediately
to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times
a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed
with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- This medication when taken as pills causes little nausea. But if you should
experience nausea, take anti-nausea medications as prescribed by your doctor, and
eat small frequent meals. Sucking on lozenges and chewing gum may also help.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
Monitoring and Testing:
You will be checked regularly by your health care professional while you are taking
L-PAM, to monitor side effects and check your response to therapy. Periodic
blood work to monitor your complete blood count (CBC) as well as the function of
other organs (such as your kidneys and liver) will also be ordered by your doctor.
How L-PAM Works:
Cancerous tumors are characterized by cell division, which is no longer controlled
as it is in normal tissue. "Normal" cells stop dividing when they come
into contact with like cells, a mechanism known as contact inhibition. Cancerous
cells lose this ability. Cancer cells no longer have the normal checks and
balances in place that control and limit cell division. The process of cell
division, whether normal or cancerous cells, is through the cell cycle. The
cell cycle goes from the resting phase, through active growing phases, and then
to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt
cell division. Usually, the drugs work by damaging the RNA or DNA that tells
the cell how to copy itself in division. If the cells are unable to divide,
they die. The faster the cells are dividing, the more likely it is that chemotherapy
will kill the cells, causing the tumor to shrink. They also induce cell suicide
(self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle
specific. Chemotherapy drugs that affect cells when they are at rest are called
cell-cycle non-specific. The scheduling of chemotherapy is set based on the
type of cells, rate at which they divide, and the time at which a given drug is
likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing.
Unfortunately, chemotherapy does not know the difference between the cancerous cells
and the normal cells. The "normal" cells will grow back and be healthy but in the
meantime, side effects occur. The "normal" cells most commonly affected by
chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and
the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea,
and/or hair loss. Different drugs may affect different parts of the body.
L-PAM is classified as an alkylating agent. Alkylating agents are most active
in the resting phase of the cell. These drugs are cell cycle non-specific.
There are several types of alkylating agents:
- Mustard gas derivatives: Mechlorethamine, Cyclophosphamide,
Chlorambucil, L-PAM, and Ifosfamide.
- Ethylenimines: Thiotepa and Hexamethylmelamine.
- Alkylsulfonates: Busulfan.
- Hydrazines and Triazines: Altretamine, Procarbazine, Dacarbazine
- Nitrosureas: Carmustine, Lomustine and Streptozocin.
Nitrosureas are unique because, unlike most chemotherapy, they can cross the blood-brain
barrier. They can be useful in treating brain tumors.
- Metal salts: Carboplatin, Cisplatin, and Oxaliplatin.
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org