Parenteral Manual

Nelarabine (INVESTIGATIONAL)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ATRIANCE, ARRANON, 506U78
Classification: 
Antimetabolite, Antineoplastic Agent - CYTOTOXIC
Original Date: 
February 2008
Revised Date: 
June 2015
Indications: 
  • T-cell Acute Lymphoblastic Leukemia
  • T-cell Lymphoblastic Lymphoma

THIS MEDICATION IS TO BE ADMINISTERED BY A CHEMO-TRAINED NURSE. IF THE NURSE IS NOT CHEMO-TRAINED, THEY ARE TO CONTACT THE UNIT NURSE EDUCATOR OR ADVANCED PRACTICE NURSE.

Reconstitution and Stability: 
  • Available as a 5 mg/mL (50 mL) solution.
  • Store at room temperature. Do not refrigerate vials - crystallization may occur.
  • Solution is used full strength directly from the vial or transferred to a glass or PVC container. No further dilution is required.
  • Punctured vials and transferred solutions are stable 8 hours at room temperature.
Compatibility: 

- Solutions Compatible:  0.9% NaCl

- Additives/bAbove CassetteCompatible: no information

- Y-site Compatible: no information

- Incompatible: no information

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct NO
IV Intermittent Infusion

YES

Undiluted
Infusion time: 1-2 hours

IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric

 

-T-cell acute lymphoblastic leukemia, T-cell lymphoma, T-cell lymphoblastic lymphoma

 650 mg/m2 IV over 1 hour daily for 5  consecutive days repeated every 21 days

 

Adult

 

-T-cell acute lymphoblastic leukemia, T-cell lymphoma, T-cell lymphoblastic lymphoma

 1500 mg/m2 IV over 2 hours on days 1, 3, and 5 repeated every 21 days

Potential hazards of parenteral administration: 
  •  Dose-limiting toxicity of nelarabine is neurotoxicity. Observe closely for signs and symptoms (severe somnolence, confusion, convulsions, ataxia, paresthesia, coma, ascending neuropathy or craniospinal demyelination).  If neurologic toxicity develops prior to completion of 5 days therapy, Nelarabine should be halted and the study chair should be contacted immediately. If Grade 4 Nelarabine-related neurotoxicity develops, the patient will be taken off Nelarabine indefinitely.
  • Common adverse reactions - abdominal discomfort and pain, diarrhea, headache, somnolence, fever, edema and myelosuppression.
  • Appropriate measures must be taken to prevent hyperuricemia or tumor lysis syndrome
  • Non-vesicant
Notes: 
  • Patients treated previously or concurrently with intrathecal chemotherapy or treated previously with craniospinal irradiation may be at increased risk for neurologic adverse events.
  • Use caution in patients with renal impairment and with severe hepatic impairment.

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