Common brand names

• Arranon

How it is administered

Nelarabine is administered as an intravenous (IV) infusion. It is available as a clear, colorless solution in single-dose vials, each containing 250 mg of nelarabine (5 mg/mL).

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

Nelarabine is not given as a pill or injection into the muscle or under the skin. It is only for IV infusion, and should be administered in a clinical 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 to its active form, 9-β-D-arabinofuranosylguanine (ara-G).

After administration, nelarabine is rapidly converted by an enzyme called adenosine deaminase (ADA) into ara-G. This active molecule is then further processed inside cells to form ara-GTP, which accumulates in cancerous T-cells (the type of cells involved in T-cell prolymphocytic leukemia and other T-cell blood cancers). Ara-GTP is incorporated into the DNA of these cells, disrupting their ability to replicate and repair themselves. This leads to inhibition of DNA synthesis and ultimately causes the cancer cells to die.

Nelarabine is especially effective against T-cell malignancies because these cells are particularly sensitive to the buildup of ara-GTP.

Who should take it

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

It is most commonly used in patients who have relapsed or refractory T-cell blood cancers, including T-cell prolymphocytic leukemia, when other treatments have not been effective. Nelarabine may also be used as part of a treatment plan before stem cell transplantation in some cases.

Your healthcare team will determine if nelarabine is appropriate based on your diagnosis, previous treatments, and overall health.

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 previously received treatments that can affect the nervous system (such as intrathecal chemotherapy or craniospinal irradiation) may be at higher risk for serious side effects and should be monitored closely.

Nelarabine can cause fetal harm, so it should not be used during pregnancy unless clearly needed. Women of childbearing potential should use effective contraception during treatment, and men should use condoms during treatment and for 3 months after the last dose. Nelarabine should not be used in patients who are breastfeeding.

Patients with significant kidney or liver impairment should be monitored closely, as safety data in these populations are limited.

Commonly used with

Nelarabine may be used alone or in combination with other chemotherapy agents, especially in clinical trials or as part of multi-agent regimens for T-cell blood cancers.

It is sometimes given as part of a chemotherapy plan before stem cell transplantation. Supportive medications, such as anti-nausea drugs, antibiotics, and medications to prevent tumor lysis syndrome (like allopurinol), may also be used alongside nelarabine.

Commonly tested with

Nelarabine has been studied in combination with multi-agent chemotherapy regimens, such as the augmented Berlin-Frankfurt-Münster (aBFM) regimen, particularly in pediatric and young adult patients with T-cell acute lymphoblastic leukemia or lymphoma.

It should not be used together with adenosine deaminase (ADA) inhibitors, such as pentostatin, as this can interfere with how nelarabine is activated in the body and may reduce its effectiveness.