How it is administered

Nelarabine is given as an intravenous (IV) infusion, meaning it is delivered directly into a vein through a needle or catheter.

For adults, the typical dose is 1,500 mg/m² administered over 2 hours on days 1, 3, and 5 of a 21-day cycle. For children (age 1 year and older), the usual dose is 650 mg/m² given over 1 hour daily for 5 consecutive days, also repeated every 21 days.

Nelarabine is supplied as a clear, colorless solution in single-dose vials and is not mixed with other fluids before infusion. The medication is administered in a hospital or clinic setting by healthcare professionals.

How it works

Nelarabine is a type of chemotherapy known as a nucleoside metabolic inhibitor. It is a prodrug, which means it is converted in the body into its active form, called ara-G.

Once inside the body, nelarabine is changed by an enzyme into ara-G, which is then further converted into ara-GTP. This active substance accumulates in cancerous T-cells (the type of white blood cell involved in T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma). Ara-GTP is incorporated into the DNA of these cells, blocking their ability to make new DNA. This stops the cancer cells from growing and dividing, eventually leading to their death.

Because nelarabine targets rapidly dividing cells, it can also affect healthy cells that divide quickly, which is why side effects can occur.

Who Should take it

Nelarabine is specifically indicated for adults and children (age 1 year and older) who have T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LBL) that has not responded to, or has relapsed after, at least two prior chemotherapy regimens.

It is used when other standard treatments have not been effective, and may be part of the treatment plan before a stem cell transplant. Nelarabine is not used for other types of leukemia or lymphoma, and its use is limited to patients with T-cell disease.

Who should not take it

There are no absolute contraindications listed for nelarabine, but it should be used with caution in certain situations.

Patients with a history of severe neurological disorders or who have received prior treatments that can affect the nervous system (such as intrathecal chemotherapy or craniospinal irradiation) may be at higher risk for serious side effects. Nelarabine can cause harm to an unborn baby, so it should not be used during pregnancy unless clearly needed. Women of childbearing age should use effective contraception, and men should use condoms during treatment and for 3 months after the last dose.

Patients should not receive live vaccines while on nelarabine, and those with significant kidney or liver impairment should be monitored closely, as the drug has not been well studied in these populations.

Commonly used with

Nelarabine may be used alone, but it is also sometimes given as part of a combination chemotherapy regimen, especially in clinical trials or specialized treatment protocols.

In some cases, it is used with other chemotherapy agents as part of a multi-agent regimen for T-cell acute lymphoblastic leukemia or lymphoma, particularly in children and young adults.

Commonly tested with

Nelarabine has been studied in combination with multi-agent chemotherapy regimens, such as the augmented Berlin-Frankfurt-Münster (aBFM) protocol, especially in pediatric and adolescent patients with T-ALL or T-LBL.

It has also been tested with other chemotherapy drugs, but should not be combined with adenosine deaminase (ADA) inhibitors like pentostatin, as this can interfere with how nelarabine works.