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Melphalan (Alkeran®) Erythrocyte Agglutinin and Hemolytic Anemia

Ann Intern Med. 1967;66(3):573-577. doi:10.7326/0003-4819-66-3-573
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L-phenylalanine mustard (melphalan) is one of the most effective drugs currently available for the treatment of multiple myeloma. Toxic effects are thrombocytopenia and neutropenia. Milder side effects include nausea, vomiting, and dermatitis. Drug hypersensitivity with hemolytic anemia has not been reported.

The present report describes a 62-year-old white man with multiple myeloma who developed a hemolytic anemia while being treated with melphalan (Alkeran®). Since no inherent red cell enzyme defect was apparent, the possibility of an immunologic mechanism was investigated. It was demonstrated that the patient's serum caused in vitro agglutination of compatible normal type O Rho red cells in


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