(nel AY re been)
Trade Name: Arranon®
Nelarabine is the generic name for the trade name chemotherapy drug Arranon. In some cases, health care professionals may use the trade name Arranon when referring to the generic drug name Nelarabine.
Drug Type: Nelarabine is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "antimetabolite." (For more detail, see "How Nelarabine Works" below).
What Nelarabine Is Used For:
- Nelarabine is used to treat T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) whose disease has not responded to or has relapsed following treatment with at least two chemotherapy regimens.
Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.
How Nelarabine Is Given
- By intravenous (IV) infusion.
- IV hydration is often recommended before Nelarabine.
- A medication named allopurinol may also be used.
- The amount of Nelarabine that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated. Your doctor will determine your dose and schedule.
Important things to remember about the side effects of Nelarabine:
- Most people do not experience all of the Nelarabine side effects listed.
- Nelarabine side effects are often predictable in terms of their onset and duration.
- Nelarabine side effects are almost always reversible and will go away after treatment is complete.
- Nelarabine side effects may be quite manageable. There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the effectiveness of Nelarabine.
The following side effects are common (occurring in greater than 30%) for patients taking Nelarabine:
These side effects are less common (occurring in about 10-29%) of patients receiving Nelarabine:
Nelarabine may cause serious system problems including: extreme sleepiness, numbness and tingling in the hands, fingers, feet or toes (peripheral neuropathy). Also reported rarely; seizures, coma, weakness and paralysis.
Tumor lysis syndrome may occur as a result of leukemia treatment. Tumor lysis syndrome occurs when large amount of cancerous cells are rapidly killed by the therapy. These cells release uric acid, potassium and phosphorus into the blood stream. Tumor lysis syndrome can lead to kidney failure. Tumor lysis syndrome usually occurs within 24-48 hours of therapy. Care must be taken to prevent the development of tumor lysis syndrome. Your health care provider will prescribe plenty of fluids to keep you hydrated. You may be given a drug called allopurinol that blocks uric acid production. In some cases, your health care provider may prescribe other measures to lower your white blood count before therapy. Let your health care provider know immediately if you are unable to urinate. Your health care provider will monitor your progress carefully during therapy.
During infusion of nelarabine you may experience confusion, sleepiness, tingling in the hands and feet (peripheral neuropathy), diarrhea, nausea and swelling (edema) in the arms or legs.
Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here. However, you should always inform your health care provider if you experience any unusual symptoms.
When to Contact Your Doctor or Health Care Provider:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:
- Fever of 100.4 F (38C) or higher, chills (possible signs of infection).
- Seizures, confusion, extreme sleepiness, numbness/tingling or extreme weakness.
The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:
- Nausea (interferes with ability to eat and unrelieved with prescribed medication)
- Vomiting (vomiting more than 4-5 times in a 24 hour period)
- Diarrhea (4-6 episodes in a 24-hour period)
- Extreme fatigue (unable to carry on self-care activities)
- Constipation unrelieved by laxative use
- Numbness and tingling in the hands, fingers, feet or toes
- Problems with fine motor skills such as buttoning clothes
- Unsteady while walking or increased tripping while walking
- Weakness when getting out of a chair or walking up stairs
- Swelling of the feet or ankles. Sudden weight gain.
- Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness
- Unable to urinate
- Unusual bleeding or bruising
- Black or tarry stools, or blood in your stools
- Blood in the urine
- Chest pain or pressure or a fast heartbeat
Always inform your health care provider if you experience any unusual symptoms.
- Before starting Nelarabine treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
- Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor's approval while taking Nelarabine
- Inform your health care professional if you are pregnant or may be pregnant prior to starting Nelarabine. Pregnancy category D (nelarabine may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
- For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking Nelarabine. Barrier methods of contraception, such as condoms are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking Nelarabine and for 60 days following the last dose.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
- You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- This medication causes little nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
- Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by this medicine.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
- Acetaminophen or ibuprofen may help relieve discomfort from fever, headache and/or generalized aches and pains. However, be sure to talk with your doctor before taking it.
Monitoring and Testing While Taking Nelarabine
You will be check regularly by your health care professional while you are taking nelarabine to monitor side effects and check your response to therapy. Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor. Before and throughout treatment with nelarabine, swelling (edema) in your arms and legs may be monitored.
How Nelarabine Works
Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition. Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division. The process of cell division, whether normal or cancerous cells, is through the cell cycle. The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division. Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific. Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific. The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing. Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur. The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss. Different drugs may affect different parts of the body.
Nelarabine belongs to the class of chemotherapy drugs called antimetabolites. Antimetabolites are very similar to normal substances within the cell. When the cells incorporate these substances into the cellular metabolism, they are unable to divide. Antimetabolites are cell-cycle specific. They attack cells at very specific phases in the cycle. Antimetabolites are classified according to the substances with which they interfere. Nelarabine is classified as an adenosine deaminase inhibitor.
Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.
- Nelarabine [package insert]. Research Triangle Park, NC: GlaxoSmithKline; December 2011 [December 2011; April 2017]. Available from: https://www.accessdata.fda.gov/drugsat-fda_docs/label/2012/021877s005lol.pdf
- Nelarabine. Lexicomp Online [April 10, 2017; April 13, 2017]. Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc.; April 13, 2017.