Inhibits DNA synthesis, leading to cell death.

Adult Dosage: 1,500 mg/m² IV over 2 hours on days 1, 3, and 5, repeated every 21 days.

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

Indicated for the treatment of patients with T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) whose disease has not responded to or has relapsed following treatment with at least two chemotherapy regimens.

• Neurotoxicity (somnolence, confusion, convulsions, ataxia, paraesthesias, and hypoesthesia) is the dose-limiting toxicity. Severe neurologic toxicity may include coma, status epilepticus, craniospinal demyelination, or ascending neuropathy similar to Guillain-Barré syndrome in presentation.
• Gastrointestinal (GI): nausea, diarrhea, vomiting, and constipation.
• Hematologic: anemia, neutropenia, and thrombocytopenia, febrile neutropenia.
• Headache, increased transaminase levels, decreased blood potassium, decreased blood albumin, increased blood bilirubin, fatigue; cough and dyspnea.

• Monitor closely for signs and symptoms of neurologic toxicity. Nelarabine should be discontinued for neurologic events of NCI Common Toxicity Criteria grade 2 or greater. Dosage may be delayed for other toxicity including hematologic toxicity.
• Patients treated previously or concurrently with intrathecal chemotherapy or previously with craniospinal irradiation may be at increased risk for neurologic adverse events.
• Complete blood counts including platelets should be monitored regularly.
• Appropriate measures (e.g., hydration, urine alkalinization, and prophylaxis with allopurinol) must be taken to prevent hyperuricemia of tumor lysis syndrome.
• Administer undiluted.