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Nelarabine (Atriance)

Find out what nelarabine is, how you have it and other important information about taking this drug. 

Nelarabine is a chemotherapy drug and is also known by its brand name, Atriance.

It is treatment for:

  •  T cell acute lymphoblastic leukaemia 
  •  T cell lymphoblastic lymphoma

 Nelarabine is licensed for people who have already had at least two other chemotherapy treatments and their leukaemia or lymphoma has come back.

How nelarabine works

Nelarabine is from a group of drugs known as anti metabolites. 

Anti metabolites are similar to normal body molecules but they have a slightly different structure. They stop leukaemia and lymphoma cells making and repairing DNA so the cells can't grow and multiply. 

How you have nelarabine

You have nelarabine as a drip (infusion) into your bloodstream (intravenously). 

Drugs into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

When you have it

You usually have nelarabine as a course of several cycles of treatment. Each cycle of treatment lasts 21 days (3 weeks). 

You have each treatment cycle in the following way: 

Day 1
  • You have nelarabine as a drip into your bloodstream over 2 hours
Day 2
  • You have no treatment
Day 3
  • You have nelarabine as a drip into your bloodstream
Day 4
  • You have no treatment
Day 5
  • You have nelarabine as a drip into your bloodstream
Day 6 to 21
  • You have no treatment

Then you start the cycle again with more nelarabine treatment. If you are aged 21 or younger, you usually have nelarabine infusion once a day for 5 days. The treatment is repeated every 3 weeks. 

Drip to stop the build up of uric acid

As well as the nelarabine you also have a drip to help stop the build up of uric acid. Uric acid can build up in your body when cancer cells are broken down. 

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.


Don’t breastfeed during this treatment because the drug may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.


Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

Sodium and nelarabine

This drug contains sodium (salt). You might need to take account of this if you are on a controlled sodium diet. Tell your doctor if you are on a low salt diet. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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