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Nelarabine

(nell-air-uh-bean)

Trade/other name(s): Arranon

Why would this drug be used?

Nelarabine is used to treat adults and children with T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL).

How does this drug work?

Nelarabine injection is part of a general group of chemotherapy drugs known as anti-metabolites. It prevents cells from making DNA and RNA. This disrupts the growth of cancer cells.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), heart disease, congestive heart failure, diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If nelarabine is given with pentostatin (another chemotherapy drug), it can greatly increase the risk of severe lung damage.

Any drugs or supplements that interfere with blood clotting can raise the risk of bleeding during treatment with nelarabine. These include:

  • vitamin E
  • non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • warfarin (Coumadin)
  • ticlopidine (Ticlid)
  • clopidogrel (Plavix)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

In adults, nelarabine injection is given in a vein over a 2-hour period on the first, third and fifth day of treatment. This sequence is repeated every 3 weeks. In children, it is given in a vein over a 1-hour period each day for 5 days. This 5-day course is repeated every 3 weeks. The dose will depend on your size, your blood counts, and the cancer that is being treated. The dose may be delayed if your blood counts are down, and may be stopped if you have serious side effects.

Precautions

This drug may make you feel drowsy. Do not drive or operate heavy machinery until you know how the drug affects you. Use caution if taking cold or allergy medicines, sedatives, anxiety medicines, or sleeping pills or if consuming alcohol while taking this medicine. Talk to your doctor or nurse if you feel too drowsy or it does not go away.

Do not get any immunizations (vaccines), either during or after treatment with nelarabine, without your doctor's OK. Nelarabine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after your treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it altogether. Keep all your appointments for lab tests and doctor visits.

Nelarabine can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

Nelarabine may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding, such as aspirin or aspirin-containing medicines, warfarin (Coumadin), or vitamin E. Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

Nelarabine may lower your red blood cell count. If this occurs, it is usually a few weeks after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

Nelarabine injection can cause nervous system problems such as feeling very sleepy, numbness and tingling of your fingertips, hands, toes, or feet; weakness; and rarely, seizures, paralysis, and coma. Call your doctor right away if you notice any of these problems:

  • numbness and tingling in your fingers, hands, toes, or feet
  • problems using your fingers such as buttoning your clothes
  • unsteadiness or tripping when walking
  • weakness when getting out of chairs or climbing stairs
  • uncontrollable shaking of any part of your body
  • seizures (convulsions)
  • losing consciousness (passing out or fainting)

Some of these symptoms may not completely go away when treatment is stopped.

This drug can cause the rapid killing of tumor cells, which in some cases has led to serious kidney damage within the first 24 hours of treatment (a condition known as tumor lysis syndrome). This is more likely if you have a very large number of cancer cells in the body. If your doctor feels you might be at risk, he or she will give you medicines and/or fluids to help prevent this. If you notice pain in your back or side, or blood in your urine, call your doctor right away.

Avoid conceiving a baby during and for some time after treatment with this drug. Talk with your doctor about how you might do this.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • low white blood cell count with increased risk of infection*
  • low platelet count with increased risk of bleeding*
  • low red blood cell count with symptoms such as feeling tired or short of breath*
  • tiredness (fatigue)
  • headache

Less common

  • nausea
  • vomiting
  • diarrhea
  • constipation
  • fever
  • infection*
  • having no energy
  • swelling of feet, legs, or hands
  • pain or swelling in the belly
  • muscle aches
  • cough
  • trouble breathing, shortness of breath
  • loss of appetite
  • bleeding*
  • nervous system problems like sleepiness, weakness, numbness or tingling*

Rare

  • fast heart beat (tachycardia)
  • mouth sores
  • trouble walking (gait)*
  • aches in your joints or bones (arthralgias)
  • abdominal (belly) pain or swelling
  • muscle weakness*
  • feeling confused*
  • seizures*
  • depression
  • trouble sleeping
  • low blood pressure
  • dehydration
  • nosebleed
  • abnormal blood tests which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)
  • death due to infection, bleeding, lung problems, nervous system effects, or other causes

*See "Precautions" section for more detailed information.

Other side effects not listed above can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 2005.

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 02/01/2010
Last Revised: 02/01/2010