Evomela (Melphalan) for Multiple Myeloma

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Evomela (melphalan) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for use as a high-dose conditioning treatment before a stem cell transplant in adults with multiple myeloma.

What Members Say

MHT logo These insights are based on 218 comments about Evomela from MyMyelomaTeam members. These are the experiences of a small number of individuals and are not meant to be medical advice.

Benefits:

Response often deepens after transplant, and remission is possible for some individuals.
Appetite changes often improve over time during recovery.
Anti-nausea medicines can make stomach side effects more manageable.
Chewing ice during infusion can help reduce mouth sores.
Walking and light activity can support strength during recovery.

Considerations:

Evomela is given by IV before stem cell transplant, often through a central line.
Nausea, vomiting, diarrhea, fatigue, and low appetite are common.
Severe low blood counts can make infection and bleeding risks especially high after treatment.
Mouth sores and an inflamed mouth or throat can make eating difficult.
Recovery can take weeks to months, with weakness and low stamina lingering.

How Evomela Works and How It’s Taken

Evomela is a type of chemotherapy medication called an alkylating agent. It works by attaching to DNA and creating links between DNA strands. This damages genetic material in cells and can make it harder for cancer cells to replicate or survive.

Evomela is used as a high-dose conditioning treatment before a stem cell transplant. Doctors prescribe Evomela when an adult with multiple myeloma is receiving high-dose conditioning treatment before an autologous stem cell transplant.

Evomela is given as an intravenous (IV) infusion, typically over 30 minutes once daily for two consecutive days before an autologous stem cell transplant.

The recommended dose of Evomela is 100 milligrams per square meter of body surface area per day, given over 30 minutes by IV infusion for two consecutive days, on day -3 and day -2 before stem cell transplantation (day 0).

This dose is based on body surface area, which is a standard calculation using height and weight to help healthcare providers choose the right dose.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Top Advice From Members on Evomela

MHT logo These insights are based on 218 comments about Evomela from MyMyelomaTeam members.

Members who use Evomela often say it helps to prepare for a tough but time-limited recovery period around stem cell transplant. Across the community, people most often mention preventing mouth sores, staying active, planning for treatment logistics, managing nausea and appetite changes, and taking extra care to avoid infections while blood counts are low.

1

Chew ice during the Evomela infusion.
“They have you chewing ice during the Melphalan infusion to reduce mouth sores.”
2

Stay ahead of nausea and eating problems.
“Firstly, after my SCT/BMT I had zero appetite, the dose of melphalan suppressed any desire to eat. I ended up drinking Ensure or Boost protein shakes to put something in my stomach.”
3

Take extra precautions to avoid infections after transplant.
“They give you a dose of Melphalan and it kills off almost all of your white blood cells. You have 0 immunity.”
4

Walk as much as you can during recovery.
“I can’t stress more than anything to start some form of exercise routine. I was going for walks, doing stair exercises and very light weights. It got my appetite back slowly.”

Connect with others who understand life with multiple myeloma. Join MyMyelomaTeam for free.

Evomela Side Effects

In clinical trials of Evomela, the most common side effects occurred in at least 50 percent of people. They include:

Neutrophil count decreased (low neutrophil count)
White blood cell count decreased
Lymphocyte count decreased (low lymphocyte count)
Platelet count decreased (low platelet count)
Anemia (low red blood cell count)
Diarrhea
Nausea
Fatigue (feeling very tired)
Hypokalemia (low potassium level)
Vomiting

Serious Side Effects and Warnings

Evomela can cause serious side effects, some of which may require immediate medical attention. These include:

Severe bone marrow suppression — Severely low blood cell counts can lead to serious infections, bleeding, or anemia.
Hypersensitivity reactions, including anaphylaxis — Serious allergic reactions can occur and may require immediate treatment.
Leukemogenicity and secondary malignancies — New cancers, including acute leukemia, have been reported after melphalan-containing treatment.
Severe mouth and digestive tract sores (mucositis) — Painful inflammation and sores can develop in the lining of the mouth, throat, stomach, or other areas of the digestive tract.
Severe nausea, vomiting, or diarrhea — These side effects can lead to dehydration and other complications.
Hepatotoxicity (liver problems) — This may include hepatitis, jaundice, or hepatic veno-occlusive disease, which affects blood flow through the liver.
Embryo-fetal harm — Evomela can harm a developing baby during pregnancy.
Infertility — Evomela may affect the ability to have children in females and males.

Get medical help right away if you think you are having a serious reaction.

How To Save on Evomela

Acrotech Biopharma, the manufacturer of Evomela, offers patient access and reimbursement support.

To learn more, visit Acrotech Patient Access or call 888-537-8277.

What To Know Before Taking Evomela

Tell your doctor if you have any allergies to melphalan or any ingredients in Evomela.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, and supplements.

Before receiving Evomela, tell your healthcare provider about all of your medical conditions, including if you:

Have an infection
Have had chemotherapy treatment
Have nausea, vomiting, or diarrhea

Do not take Evomela if you have had a serious allergic reaction to melphalan.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Evomela, talk with your doctor about the risks and benefits.

Evomela can harm a developing baby, including increasing the risk of prenatal death. If you can become pregnant, use effective birth control during treatment and for six months after your last dose. If you are male and have a partner who can become pregnant, use effective birth control during treatment and for three months after your last dose.

Do not breastfeed during treatment and for one week after your last dose.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Evomela?

Researchers evaluated Evomela’s effectiveness by comparing people’s disease responses before the stem cell transplant with their responses 90 to 100 days after the transplant, using International Myeloma Working Group criteria.

In a clinical study of 61 people with multiple myeloma who received Evomela before an autologous stem cell transplant, the overall response rate improved from 79 percent before transplant to 95 percent at 90 to 100 days after transplant. The percentage of people with a stringent complete response (a state of remission) increased from 0 percent before transplant to 16 percent after transplant.

Can Evomela cause nausea, diarrhea, or mouth sores in people with multiple myeloma?

Yes. In a clinical study of people with multiple myeloma who received Evomela before an autologous stem cell transplant, diarrhea occurred in 93 percent of people, nausea in 90 percent, vomiting in 64 percent, inflammation in the mouth in 38 percent, and stomatitis (mouth sores) in 28 percent.

What tests or monitoring are needed with Evomela?

Blood tests are needed before and during treatment with Evomela.

Complete blood counts should be monitored because Evomela causes bone marrow suppression, which can lower white blood cells, red blood cells, and platelets. Liver function should also be monitored during treatment.

Supportive care for infections, anemia, and low platelet counts may be needed until blood counts recover. Monitoring of blood cell counts and liver function tests may continue after treatment until recovery or resolution.

Your doctor will decide what is right for you.