Classifications: antineoplastic; pyrimidine, antimetabolite; Therapeutic: antineoplastic; antimetabolite
Pregnancy Category: D
5 mg/mL solution
Nelarabine inhibits DNA synthesis in lymphoblastic T-cells of acute leukemia and lymphoma.
The incorporation of a nelarabine metabolite in the leukemic blast cells halts DNA synthesis and causes cell death.
Treatment of patients with T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma.
Severe bone marrow suppression; older adults; pregnancy (category D); lactation.
Severe renal impairment, renal failure; hepatic impairment.
Route & Dosage
|Adult T-Cell Leukemia/Lymphoma
Adult: IV 1500 mg/m2 over 2 h on days 1, 3, and 5, repeated every 21 d
Child: IV 650 mg/m2 over 1 h for 5 d, repeated every 21 d
- Standard IV hydration, urine alkalinization, and prophylaxis with allopurinol are advised to manage hyperuricemia in those
at risk for tumor lysis syndrome.
- Use gloves and protective clothing to prevent skin contact.
PREPARE: IV Infusion: Do not dilute. Transfer the required dose to a PVC or glass container for infusion.
ADMINISTER: IV Infusion for Adult: Give over 2 h. IV Infusion for Child: Give over 1 h. ??Discontinue IV and notify physician for neurologic adverse events of NCI Common Toxicity Criteria grade 2 or greater.
- Store vials at 15°30° C (59°86° F). Nelarabine is stable in PVC bags or glass infusion containers
for 8 h up to 30° C.
Adverse Effects (≥1%)Body as a Whole:
Abnormal gait, fatigue, pyrexia,
rigors. CNS: Asthenia,
ataxia, dizziness, headache, hypoesthesia, neuropathy, paresthesia, somnolence,
Chest pain, edema,
sinus tachycardia. GI:
Abdominal pain, constipation, diarrhea, nausea, vomiting, stomatitis
. Hematologic/Lymphatic: Anemia, neutropenia, thrombocytopenia,
increased risk of infection
AST levels increased. Metabolic:
Anorexia, dehydration, hyperglycemia. Musculoskeletal: Arthralgia
, back pain, muscular weakness, myalgia,
pain in extremities. Respiratory: Cough, dyspnea, pleural effusion,
Bioactivation to ara-GTP, oxidized to uric acid. Elimination: Renal
3 h (active metabolite
Assessment & Drug Effects
- Monitor for and report immediately S&S of adverse CNS effects, including altered mental status (e.g., confusion, severe
somnolence), seizures, and peripheral neuropathy (e.g., numbness, paresthesias, motor weakness, ataxia, paralysis). Note:
Previous or concurrent treatment with intrathecal chemotherapy or previous craniospinal irradiation may increase risk of
- Monitor for S&S of bleeding, especially with platelet counts <50,000/mm3.
- Lab tests: Baseline and periodic CBC with differential and platelet count; periodic serum electrolytes, serum uric acid,
LFTs, and renal function test.
- Monitor diabetics for loss of glycemic control.
- Note: Previous or concurrent treatment with intrathecal chemotherapy or previous craniospinal irradiation may increase risk
of CNS toxicity.
Patient & Family Education
- Do not drive or engage in potentially hazardous activities until response to drug is known.
- Report any of the following to a health care provider: seizures; tingling or numbness in hands and feet; problems with fine
motor coordination; unsteady gait and increased weakness with ambulating; fever or other signs of infections; black tarry
stools, blood tinged urine, or other signs of bleeding.
- Use effective contraceptive measures to avoid pregnancy while taking this drug.