Nelarabine (Specialist drug)

How it works

It is a prodrug of the deoxyguanosine analogue ara-G, which is converted intracellularly to its active triphosphate, becoming incorporated into DNA to inhibit DNA synthesis and trigger cell death.

Prescribing in practice

• Severe neurotoxicity is the dose-limiting toxicity and may be irreversible, including somnolence, peripheral neuropathy, seizures and ascending paralysis; treatment must be stopped if significant neurological events occur.
• Prescribe and administer only under the supervision of a specialist experienced in cytotoxic chemotherapy, with adequate hydration and consideration of tumour lysis prophylaxis.
• Profound myelosuppression occurs and live vaccines should be avoided during treatment.

Monitoring

Monitor full blood count regularly and assess neurological status closely before and during each cycle.

Counselling the patient

• Report any drowsiness, numbness, tingling, weakness or unsteadiness promptly as nerve effects can be serious.
• Seek urgent advice for fever or signs of infection given the risk of low blood counts.

Evidence & guidelines

Use is guided by the Summary of Product Characteristics and specialist haemato-oncology protocols.