Nelarabine (Intravenous)

Nelarabine injections treat T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia, particularly patients whose condition has relapsed or is unresponsive to first-line chemotherapy.

Overview

Nelarabine injections are generally used to treat two types of cancers:

  • T-cell acute lymphoblastic leukemia (T-ALL)
  • T-cell lymphoblastic lymphoma (T-LBL)

These are rare cancers that are difficult to treat. Some 4,000 new cases are reported each year in the United States, according to research completed by the U.S. National Library of Medicine.

Nelarabine aggressively works to restrict the growth of specific cancer cells, eventually resulting in cell death. The aim when prescribing this medicine is to help patients go into remission, though there are no guarantees.

Nelarabine is prescribed for both pediatric and adult patients. Most notably, this medicine is only used as a second option for relapsing or hard-to-treat forms of T-ALL and T-LBL.

Patients should know that along with the cancer cells, normal tissues may also be affected. Consequently, patients may feel ill when undergoing treatment. However, to fully benefit from the therapy, the complete line of treatment is needed and must be continued – even when patients do not feel well.

Please note: The side effects are temporary, though severe reactions can occur.

A benefit vs. risk assessment is generally completed before prescribing Nelarabine, and as discussed earlier, certain criteria must be met before getting a prescription from an oncologist. To qualify for Nelarabine treatments, patients must have received two previous chemotherapy regimens, which proved ineffective.

Nelarabine is available by prescription only and it is sold under the U.S. brand name Arranon. It is exclusively administered in a clinical setting by a trained medical provider.

Conditions Treated?

  • T-cell acute lymphoblastic leukemia (T-ALL)
  • T-cell lymphoblastic lymphoma (T-LBL)

Type Of Medicine?

  • Antineoplastic
  • Antimetabolite Antineoplastic Agent
  • Cytotoxic Chemotherapy Drug

Side Effects

Nelarabine comes with many possible side effects, including:

  • A dry mouth
  • A fruity breath
  • A headache
  • A loss of balance while walking
  • A sense of nervousness
  • Abnormal heartbeat
  • Appetite loss
  • Bad dreams
  • Bladder leaks
  • Bloating
  • Bloody stools or urine
  • Blurriness
  • Chest pain and tightness
  • Cold sensation
  • Dehydration
  • Difficulty focusing
  • Difficulty speaking
  • Edema
  • Eyes that look sunken
  • Feeling anxious
  • Feeling depressed or discouraged
  • Feeling irritable
  • Fevers, chills, and/or cold sweats
  • Flu-like symptoms
  • Glands that look and feel swollen
  • Gums that bleed easily
  • Immobility
  • Incontinence
  • Insomnia
  • Jaundice
  • Lethargy
  • Lethargy
  • Limpness
  • Mood changes
  • Mouth ulcers
  • Nosebleeds
  • Pain in the chest
  • Pain in the side or back
  • Pain or cramps in the stomach area
  • Pain, spasms, or weakness in the joints or muscles
  • Perspiration
  • Pins and needles sensation on the skin
  • Seizures
  • Skin that looks pale or is cool to the touch
  • Skin that looks wrinkled
  • Sleepiness
  • Spots on the skin
  • Stools that look black
  • Syncope
  • Trembling
  • Trouble breathing
  • Unconsciousness
  • Uncontrollable cravings
  • Unexplained hoarseness while talking
  • Weight loss
  • Wheezing

Most of these symptoms subside with time. However, if you suspect a severe reaction to this medicine or your side effects persist, consult your healthcare provider immediately. The most concerning side effects are:

  • Neurotoxicity
  • Coma
  • Paralysis

It is important to seek medical help when any serious adverse reactions are noticed and to educate yourself on when to call for help.

The insert label outlines that full recovery is not always guaranteed if severe side effects occur.

If you have any questions while using this medicine, consult your healthcare provider.

Rare side effects

Some of the rare side effects of this medicine include:

  • Loss of taste
  • Memory loss

Dosage

Nelarabine is typically administered in a hospital setting or at a cancer treatment facility.

It is injected into the veins by a qualified medical worker. The average doses are:

Adults: 1,500 mg | Slow IV Method for 2 Hours

This dose is given in cycles based on the patient's diagnosis. However, it is generally given once on the first day, then two days later twice. So, Day 1, 3, and 5 is the standard series. After these preliminary doses, the prescription is given every 3 weeks.

Children: 600 mg | Slow IV Method for 1 Hour

In children, this dose is generally given for 5 days in a row. After the preliminary treatment, the dose is given every three weeks.

Best practices for medical professionals

For best results, the following rules of thumb are exercised when providing treatment with Nelarabine:

1. Before injecting patients with Nelarabine, an IV hydration therapy may be administered to prevent kidney problems and help patients pass more urine.
2. Patients should also drink roughly 4 cups of water every 2-3 hours when using this medicine.
3. If serious reactions occur, including neurological issues, the prescription should be discontinued immediately.
4. To reduce the transmission of infections, care should be taken by medical workers to wear protective gear, including gloves and to dispose of any used needles and/or syringes in a biohazard waste bin.

Interactions

A number of interactions have been reported for Nelarabine:

Drug interactions

You should not take aspirins in conjunction with Nelarabine, as negative interactions are known to occur. Additionally, you should consult your doctor before using any over-the-counter treatments, such as herbs, vitamins, or St. John's Wort.

Vaccines

Many of the demonstrated drug interactions with Nelarabine include vaccinations. Patients who receive a dose of Nelarabine injections should not be given the:

  • Adenovirus Immunization
  • Live Bacillus of Calmette and Guerin Immunization
  • Live Cholera Immunization
  • Live Influenza Virus Immunization
  • Live Measles Virus Immunization
  • Live Mumps Virus Immunization
  • Live Poliovirus Immunization
  • Live Rotavirus Immunization
  • Live Rubella Virus Immunization
  • Pentostatin Immunization
  • Smallpox Immunization
  • Typhoid Immunization
  • Varicella Virus Immunization
  • Yellow Fever Immunization

Underlying medical conditions

There is also a demonstrated risk of undergoing treatment with Nelarabine when patients have the following underlying conditions:

  • Neurological disorders
  • Kidney or liver disease

Interactions With Alcohol

Limit alcohol when being treated with Nelarabine. The concomitant use of Nelarabine and alcohol may elevate feelings of sleepiness, dizziness, and trouble concentrating.

Warnings

An insert label is included with each vial of Nelarabine. Read it through carefully and note the following precautions:

Allergies

Inform your medical specialist of any past allergic reactions to any medicines, foods, or substances.

Drink plenty of fluids

To expedite the waste removal process and help you pass more urine, your doctor may advise you to drink plenty of fluids. Taking this precautionary measure is proven to reduce the chances of developing kidney issues.

Nausea

Patients who take Nelarabine commonly report feeling nauseous or sick. Your doctor may prescribe additional medicines to alleviate this side effect. However, it is important to take all the required doses for the maximum effectiveness.

To alleviate nausea, try using a lozenge that your doctor approves of.

Fainting

Nelarabine may cause you to feel lightheaded or dizzy. Fainting is moreover known to occur, especially when patients get up from sitting or lying down. To lower the risk of syncope, get up slowly after resting.

Blood tests

To determine if this medicine is working as it should, patients are advised to keep all follow-up appointments, where blood tests are drawn to check for side effects and/or progress. Expect a test for your complete blood count as well as assessments of the kidneys and liver.

Significant nervous system disorders

Nelarabine may potentially cause severe nervous system issues, especially in elderly patients or individuals who received cancer therapies for the head and back in the past. Some of the telltale signs of a nervous system problem include:

  • Numb or tingling sensation
  • Severe drowsiness
  • Convulsions
  • Imbalances while standing or walking
  • Feeling limp

If these symptoms develop, consult your healthcare provider right away.

Vaccinations

Do not get vaccinated before, during, or after treatment with Nelarabine without first consulting with your healthcare specialist.

When taking this medicine, your immune system is weakened, and this places you at a higher risk of acquiring new infections.

You should not go near others in your household who have received new vaccinations or those who are sick. A special focus is placed on the oral polio vaccine, as there have been demonstrated cases of patients getting this virus from the vaccine intended to stop it.

If you are unable to stay away from sick or newly vaccinated individuals, consider wearing a protective medical-grade mask.

Bleeding risk

In addition to lowering the immune system, Nelarabine is also proven to reduce white blood cells and platelets. Subsequently, this makes it difficult to maintain normal blood clotting processes and predisposes patients to bleeding and infections.

Patients are therefore advised to take the following extra precautions while being treated with Nelarabine:

  • Contact your doctor if you were exposed to people who are sick
  • Tell your healthcare provider if you develop a new infection, especially one accompanied by a high fever, coughing, pain, or trouble urinating
  • Use extra care when handling knives, razors, or other sharp objects
  • Alert your doctor of any bruising you notice on your skin
  • Ask your doctor about alternative ways to care for your teeth and gums, as a regular toothbrush or dental floss may aggravate the gums and cause profuse bleeding
  • Consult your medical provider about the safety of any upcoming dental procedures
  • Avoid touching your face, especially after coming into contact with public surfaces.
  • Practice washing your hands regularly with soap and running water for at least two minutes – several times per day.
  • Postpone any contact sports events or extracurricular activities, as this increases the risk of bruising

Sunburn

Your skin may burn more easily when undergoing treatment with Nelarabine. Be sure to dress for the weather when heading outdoors. You should also apply a protective sunscreen every time you head outside in the sun and cover up with a hat.

Constipation

You may feel constipated or bloated after receiving Nelarabine. Ask your doctor if it is safe to take a stool softener, and if so, what brands are recommended.

Driving

Activities like driving that require your full attention should be delegated to someone else while undergoing treatment with Nelarabine. This medicine can make you feel dizzy, lightheaded, and extremely drowsy. You may also feel nauseous and have difficulty concentrating. As a result, it's best to have a designated driver or helper to operate vehicles or other heavy machinery.

Pregnancy

Medical researchers have established that Nelarabine may cause harm to an unborn baby. In extenuating circumstances, however, such as when the mother's life is threatened, doctors may proceed with the treatment.

Tell your doctor if you are pregnant or breastfeeding before commencing treatment with Nelarabine. To prevent pregnancy, ask your healthcare provider about an effective form of birth control that is compatible with Nelarabine.

If you get pregnant while using this medicine, inform your medical provider right away.

Male patients are also advised to use a contraceptive to prevent their partners from getting pregnant.

Breastfeeding

Nelarabine may excrete into human milk and affect newborns and infants. To prevent this risk, you should not breastfeed while taking Nelarabine. Additionally, you should wait at least two months after the receiving the last dose before breastfeeding.

Seniors

Older patients taking Nelarabine may be at a more increased risk of developing nervous system issues. Seniors should therefore be closely monitored when receiving treatment.

Lifestyle changes

For best results, patients are advised to maintain a healthy lifestyle as much as possible by eating a wholesome diet and getting a full night's rest every day. If you have trouble getting or staying asleep, consult your healthcare provider for help. Do not take any OTCs without first getting an approval from your medical provider.

Storage

Nelarabine vials should be stored in the original container and at a controlled room temperature of 25° C (77° F). Avoid placing in heat, direct light, or humid areas to preserve the integrity of this medicine.

Summary

Nelarabine is a type of chemotherapy medication or antineoplastic that is generally dispensed under the trade name Arranon. It is administered intravenously in a hospital setting and is only available with a doctor's prescription.

It is intended for patients diagnosed with relapsing or aggressive forms of T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia. Nevertheless, this isn't generally the first course of treatment for these conditions.

In order to receive Nelarabine, an eligibility requirement must be passed – which includes having received two former doses of chemotherapy. If no favorable responses occur, oncologists then proceed to prescribe Nelarabine injections.

Nelarabine is known to cause several side effects, ranging from mild to severe. For the most part, these adverse reactions are predictable. Patients are usually counseled before treatment about what to expect and to plan for these reactions. To benefit from the therapy, all doses must be taken on schedule and continued treatment with Nelarabine is required, despite nausea and vomiting, for example. Your medical provider may also prescribe additional drugs to lower nausea and vomiting.

Most of the side effects associated with Nelarabine are temporary and generally subside with time. Nonetheless, serious side effects may occur, including nervous system problems, particularly in older patients or those who have previously received chemotherapy for head or back cancers.

This medicine is not recommended for nursing mothers unless it's a life-and-death scenario where the benefits outweigh the risk. A contraceptive should also be used by male and female patients before, during, and after treatment with Nelarabine in order to prevent pregnancy.

Because this medicine weakens the immune system, patients are advised to avoid other parties who are sick or newly immunized. You should also avoid getting vaccinated unless you have received consent from your healthcare provider.

To reduce dehydration, you should drink copious amounts of water daily. You should also get up slowly after sitting or lying down, as Nelarabine is proven to cause syncope. Due to the risk of fainting, patients should also avoid driving or operating heavy machinery. Instead, a designated driver should be assigned.