Nelarabine : Drug Information for Patients

About Nelarabine: Nelarabine comes under the brand name Atriance. It belongs to a group of medications named antineoplastic agents, used in chemotherapy to destroy some types of cancer cells.

Indication: injection The nelarabine injection is aimed to treat patients with:
a type of leukaemia, named T-cell acute lymphoblastic leukaemia. Leukaemia causes an abnormal boost in the number of WBCs. The abnormal increased white blood cells can appear in the blood and other parts of the body. The type of leukaemia relates to the type of WBC mainly involved. In this case, its cells are known as lymphoblasts.
a type of lymphoma, named T-cell lymphoblastic lymphoma. This lymphoma is caused by a mass of lymphoblasts, a sort of white blood cell.

Mode of Action: Nelarabine is a pro-drug of the deoxyguanosine analogue 9-ȕ-D-arabinofuranosyl guanine (ara-G). It is demethylated by the adenosine deaminase to ara-G, which is subsequently converted to the active 5′-triphosphate, ara-GTP. The leukemic blasts gather the active form enabling the incorporation into the deoxyribonucleic acid (DNA) which results in inhibiting the DNA synthesis and eventual destruction of cells.

Dosage and Route: The recommended dose of nelarabine injection in adult patients is 1,500 mg/m2 intravenously over two hours on days 1, 3 & 5 repeated every 3 weeks. The standard dose of nelarabine in pediatric patients is 650 mg/m2 intravenously over 60 minutes daily for five consecutive days repeated every 3 weeks. The duration of nelarabine therapy has not been established. During clinical trials, therapy was continued until there was evidence of disease progression, intolerable toxicity, or the patient became a recipient for bone marrow transplantation.

Common Side Effects: The most frequent side effects seen in adult patients with nelarabine were fatigue, hematologic disorders (e.g., thrombocytopenia, anemia and neutropenia), gastrointestinal (GI) disorders (e.g., diarrhea, vomiting, and nausea), nervous system disorders (e.g., dizziness and somnolence), pulmonary disorders (e.g., cough and dyspnea) and fever. In pediatrics, the most common nelarabine side effects included hematologic disorders, hypokalemia, headache, decreased albumin, hyperbilirubinemia, vomiting and increased transaminase levels.

Precautions/Contraindications: Nelarabine uses should be avoided in patients with known history of hypersensitivity to nelarabine or any of its existing components.
General: Patients taking nelarabine treatment should be managed for tumor lysis syndrome as per the standard medical practice in order to control hyperuricemia. The intravenous hydration and prophylaxis administration of allopurinol need to be considered. Patients should be made aware that seizures have been known to occur in patients with nelarabine. Any healthcare practitioner administering the atriance 250 mg should be made aware of this precaution. If this should occur, the prescribing healthcare practitioner should be immediately informed. Immunocompromised patients with nelarabine should avoid taking live vaccines.
Hematologic: Thrombocytopenia, leukopenia, neutropenia, and anemia and have also been related with nelarabine therapy. Patient blood counts including platelets should be regularly monitored.
Patient Information: Patients with nelarabine therapy may experience somnolence and need to avoid operating hazardous machines, including motorized vehicles. A doctor should be contacted in case patients experience any peripheral neuropathy including tingling or numbness, abnormal weakness and difficulty with fine motor coordination.

Pregnancy/Lactation: Nelarabine basically is a pregnancy Category D. Patients must consider effective contraceptive measures in order to avoid pregnancy. Breast-feeding mothers should also refrain from nursing infants while on the therapy with nelarabine.

Drug Interactions: There are in vitro findings that pentostatin is an impactful adenosine deaminase inhibitor, which can result in a reduced conversion of nelarabine to its active substrate. This could result in diminished the efficacy and a potential change in the adverse event profile for either drug. The combination of adenosine deaminase inhibitors and nelarabine should be avoided. Patients should inform their specialist prior to taking any over-the -counter medicines, herbals or receive flu shots and other live vaccines while on nelarabine therapy. It is recommended that patients receive live vaccines at least 2 weeks before initiating chemo or while on remission for minimum 3-months after the chemo has been finished.

Conclusions: Nelarabine has minimal findings regarding its administration as monotherapy to treat T-cell malignancies in adults. Because of this, it is hard to extrapolate the findings to the majority of the VA’s patient population. Nelarabine has demonstrated activity against T-cell leukemias as well as lymphomas in small treatment populations including pediatrics and adults as a third-line agent for the relapsed or refractory disease. Additional research is being done regarding its use along with fludarabine in patients with unsuccessful 1’st line therapy regimens. There are precise options available for patients with T-cell malignancies who fail numerous chemotherapies. Nervous system events were noted in over half of the patients treated with nelarabine, including some severe neurologic events, leading to a black box warning. Specialists must precisely monitor their patients for any kind of signs/symptoms of neurotoxicity. The nelarabine is a rather expensive drug, although cost analyses have not yet been done.

Note: The information provided in the article named “Nelarabine: Drug Information for Patients”, is just for informational purposes and it is not responsible for serving as a substitute for the medical treatment, consultation, diagnosis, of an experienced healthcare professional.