Nelarabine

Nelarabine Brand Name– Arranon

What is Nelarabine

Nelarabine is a cytotoxic purine nucleoside analog. It is indicated for the treatment of T-cell acute lymphoblastic leukemia (ALL) and T-cell lymphoblastic lymphoma in pediatric patients 1 year of age or older and adults with relapsed or refractory disease following at least 2 prior chemotherapy regimens.

Severe neurologic adverse reactions have been reported with nelarabine therapy; therefore, monitor patients closely.

Indications

• chronic lymphocytic leukemia (CLL)
• T-cell leukemia/lymphoma

For the treatment of T-cell leukemia/lymphoma

NOTE: The FDA has designated nelarabine as an orphan drug for the treatment of acute lymphoblastic leukemia and lymphoblastic lymphoma.

for the treatment of relapsed or refractory T-cell acute lymphoblastic leukemia (ALL) or T-cell lymphoblastic lymphoma following at least 2 prior chemotherapy regimens

Side Effects

1. abdominal pain
2. abdominal pain
3. amnesia
4. anemia
5. anemia
6. anorexia
7. aphasia
8. arthralgia
9. arthralgia
10. asthenia
11. asthenia
12. ataxia
13. ataxia
14. back pain
15. blurred vision
16. chest pain (unspecified)
17. chills
18. coma
19. confusion
20. confusion
21. constipation
22. constipation
23. cough
24. dehydration
25. dehydration
26. depression
27. depression
28. diarrhea
29. diarrhea
30. dizziness
31. drowsiness
32. drowsiness
33. dysarthria
34. dysesthesia
35. dysgeusia
36. dyspnea
37. dyspnea
38. edema
39. elevated hepatic enzymes
40. elevated hepatic enzymes
41. encephalopathy
42. epistaxis
43. fatigue
44. fatigue
45. fever
46. fever
47. Guillain-Barre syndrome
48. headache
49. headache
50. hydrocephalus
51. hyperbilirubinemia
52. hyperbilirubinemia
53. hyperglycemia
54. hyperglycemia
55. hypertonia
56. hyperuricemia
57. hypoalbuminemia
58. hypoalbuminemia
59. hypocalcemia
60. hypocalcemia
61. hypoesthesia
62. hypoesthesia
63. hypoglycemia
64. hypoglycemia
65. hypokalemia
66. hypokalemia
67. hypomagnesemia
68. hypomagnesemia
69. hyporeflexia
70. hypotension
71. hypotension
72. infection
73. infection
74. insomnia
75. intracranial bleeding
76. lethargy
77. leukoencephalopathy
78. leukopenia
79. leukopenia
80. muscle paralysis
81. myalgia
82. myalgia
83. nausea
84. neuropathic pain
85. neurotoxicity
86. neurotoxicity
87. neutropenia
88. neutropenia
89. nystagmus
90. paresis
91. paresthesias
92. paresthesias
93. peripheral edema
94. peripheral neuropathy
95. peripheral neuropathy
96. petechiae
97. petechiae
98. pleural effusion
99. pneumothorax
100. rhabdomyolysis
101. seizures
102. sinus tachycardia
103. sinus tachycardia
104. sinusitis
105. sinusitis
106. stomatitis
107. stomatitis
108. thrombocytopenia
109. thrombocytopenia
110. tremor
111. tumor lysis syndrome (TLS)
112. vomiting
113. vomiting
114. weakness
115. weakness
116. wheezing

Monitoring Parameters

• CBC with differential
• neurologic function
• pregnancy testing
• serum creatinine
• serum electrolytes
• serum uric acid

Contraindications

• anemia
• breast-feeding
• children
• contraception requirements
• driving or operating machinery
• geriatric
• hepatic disease
• hyperuricemia
• male-mediated teratogenicity
• neurologic events
• neurotoxicity
• neutropenia
• pregnancy
• pregnancy testing
• radiation therapy
• renal disease
• renal impairment
• reproductive risk
• thrombocytopenia
• tumor lysis syndrome (TLS)
• vaccination

Interactions

• Abciximab
• Amlodipine; Celecoxib
• Anagrelide
• Anticoagulants
• Aspirin, ASA; Dipyridamole
• Azelastine; Fluticasone
• Bacillus Calmette-Guerin Vaccine, BCG
• Beclomethasone
• Betamethasone
• Budesonide
• Budesonide; Formoterol
• Celecoxib
• Ciclesonide
• Cilostazol
• Clopidogrel
• Clozapine
• Corticosteroids
• Cortisone
• Deflazacort
• Dexamethasone
• Diclofenac
• Diclofenac; Misoprostol
• Diflunisal
• Digoxin
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Dipyridamole
• Eptifibatide
• Esomeprazole; Naproxen
• Etodolac
• Famotidine; Ibuprofen
• Febuxostat
• Fenoprofen
• Filgrastim, G-CSF
• Fludrocortisone
• Flunisolide
• Flurbiprofen
• Fluticasone
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Formoterol; Mometasone
• Hydrocodone; Ibuprofen
• Hydrocortisone
• Ibuprofen
• Ibuprofen; Oxycodone
• Ibuprofen; Pseudoephedrine
• Indomethacin
• Influenza Virus Vaccine
• Intranasal Influenza Vaccine
• Ketoprofen
• Ketorolac
• Lansoprazole; Naproxen
• Live Vaccines
• Measles Virus; Mumps Virus; Rubella Virus; Varicella Virus Vaccine, Live
• Measles/Mumps/Rubella Vaccines, MMR
• Meclofenamate Sodium
• Mefenamic Acid
• Meloxicam
• Methylprednisolone
• Mometasone
• Nabumetone
• Naproxen
• Naproxen; Pseudoephedrine
• Naproxen; Sumatriptan
• Nonsteroidal antiinflammatory drugs
• Oxaprozin
• Palifermin
• Pegfilgrastim
• Penicillamine
• Piroxicam
• Platelet Inhibitors
• Prasugrel
• Prednisolone
• Prednisone
• Rofecoxib
• Rotavirus Vaccine
• Rubella Virus Vaccine Live
• Smallpox and Monkeypox Vaccine, Live, Nonreplicating
• Smallpox Vaccine, Vaccinia Vaccine
• Sulindac
• Tbo-Filgrastim
• Ticagrelor
• Ticlopidine
• Tirofiban
• Tolmetin
• Triamcinolone
• Tuberculin Purified Protein Derivative, PPD
• Typhoid Vaccine
• Valdecoxib
• Varicella-Zoster Virus Vaccine, Live
• Vorapaxar
• Yellow Fever Vaccine, Live