nelarabine at a glance
Medicine class
Cytotoxic antimetabolite and purine analogue.
Main licensed uses
Previously treated T-cell acute lymphoblastic leukaemia and T-cell lymphoblastic lymphoma.
Administration
Given into a vein by a specialist cancer team; the solution is used without dilution.
Key safety concern
Central or peripheral nervous-system toxicity, which may not always fully resolve.
What is nelarabine used for?
The selected UK product is licensed when previous chemotherapy has been unsuccessful.
T-cell acute lymphoblastic leukaemia that has not responded to, or has relapsed after, at least two chemotherapy regimens.
T-cell lymphoblastic lymphoma that has not responded to, or has relapsed after, at least two chemotherapy regimens.
How does nelarabine work?
Nelarabine is converted into ara-G and then into its active triphosphate, ara-GTP. This builds up preferentially in malignant T cells, becomes incorporated into DNA and disrupts DNA synthesis, leading to cell death.
nelarabine preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 5 mg/mL
How to take nelarabine
Nelarabine is given into a vein under the supervision of a clinician experienced with cytotoxic treatment. It is supplied as a clear, colourless, ready-to-use infusion solution that must not be diluted. Tell the team promptly about neurological symptoms, drowsiness, or any new medicine or vaccination.
It is administered by trained healthcare professionals rather than taken at home.
Do not drive or operate machinery if drowsy; somnolence can persist for several days after treatment.
Follow the cancer team's instructions about hydration, blood tests and infection precautions.
nelarabine side effects
Common or expected effects
- Reduced red cells, white cells or platelets, which may cause tiredness, infection, bruising or bleeding
- Fatigue or weakness
- Nausea, vomiting, diarrhoea or constipation
- Headache, dizziness or drowsiness
- Numbness, tingling or other peripheral nerve symptoms
- Fever
- Cough or breathlessness
- Muscle pain, joint pain or swelling
Get urgent medical advice
- New or worsening confusion, profound drowsiness, seizures, poor coordination or loss of consciousness
- Progressive numbness, tingling, limb weakness, difficulty walking or paralysis
- Fever or other signs of serious infection
- Unusual bleeding or bruising
- Severe muscle pain or weakness, particularly with dark urine, which may indicate muscle breakdown
- Symptoms of tumour lysis syndrome, such as reduced urine, muscle cramps, weakness, vomiting or an irregular heartbeat
nelarabine in pregnancy
Human pregnancy information is very limited, but the mechanism and animal findings indicate a risk of fetal harm. Nelarabine should not be used during pregnancy unless clearly necessary. Effective contraception is advised during treatment; men whose partner is pregnant or could become pregnant should use condoms during treatment and for at least three months afterwards. Pregnancy or family-planning concerns require prompt discussion with the specialist team.
nelarabine while breastfeeding
It is unknown whether nelarabine or its metabolites enter human milk, and harm to a breastfed child cannot be excluded. Breastfeeding should be stopped during treatment; discuss feeding options with the specialist team.
nelarabine interactions
The cancer team should review prescribed, non-prescribed and complementary products before treatment.
Pentostatin and other adenosine-deaminase inhibitors
Combined use is not recommended because it may reduce nelarabine's activity or alter the adverse-effect profile of either treatment.
Intrathecal chemotherapy
Concurrent treatment is not recommended because previous or concurrent exposure may increase neurological toxicity.
Live organism vaccines
These are not recommended because immunosuppression may allow the vaccine organism to cause infection.
Common questions about nelarabine
Answers are fully visible for fast scanning and source review.
Is nelarabine chemotherapy?
Yes. Nelarabine is cytotoxic chemotherapy belonging to the purine-analogue antimetabolite class.
Which cancers is nelarabine licensed to treat in the UK?
It is licensed for previously treated T-cell acute lymphoblastic leukaemia and T-cell lymphoblastic lymphoma when disease has not responded or has relapsed.
Why is nelarabine used particularly for T-cell cancers?
Its active metabolite accumulates preferentially in malignant T cells, where it disrupts DNA synthesis.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.