II. Indications

  1. T Cell Acute Lymphoblastic Leukemia or Lymphoma (relapse or refractory)

III. Mechanism

  1. Purine Antimetabolite (arabinonucleoside) with antineoplastic activity
  2. Nelarabine is demethoxylated by Adenosine deaminase to its biologically active metabolite, Ara-G
    1. Ara-G (9-beta-D-arabinosylguanine) incorporates into DNA
    2. Inhibits DNA synthesis

IV. Medications

  1. Nelarabine IV Solution: 5 mg/ml in 50 ml vials

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Myelosuppression
  2. Neurotoxicity
    1. Altered Mental Status
    2. Demyelination (rare)
    3. Headache
    4. Paralysis
    5. Peripheral Neuropathy
    6. Seizures
    7. Somnolence

VII. Safety

  1. Avoid in Pregnancy (any trimester)
    1. Use reliable Contraception
  2. Avoid in Lactation
  3. Monitoring
    1. Renal Function Tests

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