Care During Chemotherapy and Beyond
(nel AY re been)
Trade Name: Arranon ®
Nelarabine is the generic name for the trade name chemotherapy
drug Arranon. In some cases, health
care professional may use the trade name Arranon when referring to the generic drug
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
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.
- The amount of Nelarabinethat 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
- 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.
- There are many options to help minimize or prevent side
- 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:
- Low blood counts (anemia, neutropenia, thrombocytopenia)
These side effects are less common side effects
(occurring in about 10-29%) of patients receiving Nelarabine:
- Extreme sleepiness
- Peripheral neuropathy
- Shortness of breath
- Muscle aches
- Pleural effusion
Nelarabine may cause serious nervous 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.
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 (38 C) or higher, chills (possible signs
- Seizures, confusion, extreme sleepiness.
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.
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: 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 this medication 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
- 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
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and
- 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 ibuprophen 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:
You will be checked 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.
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
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.
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.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org