Nelarabine (Atriance) | Cancer Research UK
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What nelarabine is

Nelarabine is a chemotherapy drug used to treat T cell acute lymphoblastic leukaemia and T cell lymphoblastic lymphoma. It is also called Atriance. 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

It is one of a group of drugs known as the 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 into your bloodstream (intravenously). You can have it through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have it through a central line, a portacath or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You usually have chemotherapy as a course of several cycles of treatment. Your doctor will decide on the number of cycles you need.

You have nelarabine as a drip (infusion) over 2 hours on the first day. You have no treatment the next day. Then you have nelarabine again on the 3rd and 5th days. You then have a break from treatment for 16 days. This makes up a treatment cycle of 21 days (3 weeks). Then you start the cycle again with more nelarabine treatment. 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 the body when cancer cells are broken down.

If you are aged 21 or younger you usually have nelarabine by drip once a day for 5 days. The treatment is repeated every 3 weeks. 


Tests during treatment

You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of blood cells. They also check how well your liver and kidneys are working.


About side effects

We've listed the side effects associated with nelarabine below. You can use the links to find out more about each side effect. Where there is no link, please go to our cancer drug side effects section or use the search box at the top of the page.

You may have a few side effects. They may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Tell your doctor or nurse straight away if any of the side effects get severe.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have a headache, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Tiredness and weakness (fatigue) occurs in 1 in 2 people (50%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Dizziness – don't drive or operate machinery if you have this
  • Headaches
  • Feeling or being sick affects about 4 out of every 10 people (40%) but this is usually well controlled with anti sickness medicines
  • Loss of appetite
  • Constipation in 2 out of 10 people (20%) – your doctor or nurse may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
  • Diarrhoea in more than 2 out of 10 people (20%) – drink plenty of fluid and tell your doctor or nurse if the diarrhoea becomes severe, or continues for more than 3 days
  • Muscle pain and aching
  • Tummy (abdominal) pain
  • Swollen ankles and legs due to a build up of fluid (oedema) in 15 out of 100 people (15%)
  • Severe drowsiness after treatment (somnolence) in about 1 in 10 people – this usually goes away on its own, but mention it to your doctor or nurse if you have it. Don't drive or operate machinery if you have this
  • Numbness or tingling in fingers and toes can cause difficulty with fiddly things such as doing up buttons – this starts within a few days or weeks and usually goes within a few months of finishing treatment but for some people may be permanent.
  • Abnormal sensations on the skin, such as burning or prickling or a sensation of something crawling on the skin
  • Breathlessness and a cough – some people also have wheezing
  • A high temperature (fever)
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Loss of fertility – 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

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Changes in balance and coordination, causing difficulty with walking
  • Difficulty in thinking normally – you may not be able to remember things as well as usual
  • Rhythmic shaking of one or more limbs
  • Muscle weakness
  • Joint pain
  • Mild liver changes that are unlikely to cause symptoms – the liver will usually go back to normal when treatment finishes
  • Low blood pressure
  • Back pain
  • A sore mouth
  • Blurred vision
  • Loss of taste
  • Loss of appetite and weight loss
  • Kidney changes that are unlikely to cause symptoms – the kidneys will almost certainly go back to normal when the treatment ends
  • High uric acid levels in your blood due to cancer cells being broken down by the body (tumour lysis syndrome) – you will have regular blood tests and will be asked to drink plenty of fluids to flush out the uric acid. Your doctors may also give you a drug called allopurinol
  • Fits (seizures), causing muscle spasms and unconsciousness
  • A build up of fluid around the lungs – let your doctor or nurse know if you have chest pain or difficulty breathing
  • High levels of bilirubin in the blood, causing weakness and yellowing of the skin
  • Low calcium levels in the blood, causing muscle cramps and stomach cramps
  • Low magnesium levels in the blood, causing an irregular heart beat, muscle weakness, confusion and jerky movements
  • Low potassium levels in the blood, causing weakness
  • Low glucose levels in the blood – let your doctor or nurse know if you feel sick, weak, faint, confused or have sudden sweating

Important points to remember

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

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


Do not breastfeed during this treatment because the drug may come through in the breast milk.

Sodium and nelarabine

Nelarabine contains at least 23mg of sodium per dose. You will need to take this into account if you are on a controlled sodium diet.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information


More information about nelarabine

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 24 January 2014