Purine antimetabolite
Nelarabine (Specialist drug)
Brand names: Atriance
Adult dose
Dose: Specialist initiation only — refer to BNF/SmPC
Route: IV
Frequency: per protocol
Clinical pearls
- Relapsed/refractory T-cell ALL/lymphoma
- Neurological monitoring at every cycle; stop at first sign of significant neurotoxicity
Contraindications
- Severe myelosuppression
- Severe neurological dysfunction
- Pregnancy
Side effects
- Severe neurotoxicity (peripheral neuropathy, somnolence, seizures, demyelination — black box)
- Severe myelosuppression
- Tumour lysis syndrome
Interactions
- Live vaccines
- Adenosine deaminase inhibitors
Monitoring
- FBC
- Neurological exam
- U&E
- Uric acid
Reference: BNF; SmPC; https://bnf.nice.org.uk/drugs/nelarabine-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Vancomycin Dosing Calculator · Drug Dosing
- Phenytoin Correction for Albumin / Renal Failure · Drug Dosing
- Local Anaesthetic Maximum Dose Calculator · Drug Dosing
- Tisdale Risk Score for QT Prolongation · Arrhythmia
- Bazett Corrected QT Interval (QTc) Calculator · Arrhythmia
- DAPT Score for Dual Antiplatelet Therapy Duration · Antiplatelet Therapy
Pathways
- Acute Myeloid Leukaemia Presentation · BSH; NICE — NG146
- Tumour Lysis Syndrome · Cairo-Bishop; BSH; NICE — Best Practice
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158