Nelarabine (Atriance)

Nelarabine is a chemotherapy drug used to treat T cell acute lymphoblastic leukaemia and T cell lymphoblastic lymphoma. It is licensed for people who have already had at least two other chemotherapy treatments and their leukaemia or lymphoma has come back.

Nelarabine is also called Atriance. 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 cancer cells making and repairing DNA so the cells can’t grow and multiply.

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. The number of cycles you have depends on your treatment plan. There is detailed information about the way doctors plan chemotherapy in the planning chemotherapy section.

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. 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.

The side effects associated with nelarabine are listed below. You can use the links to find out more about each effect. For general information, see our cancer drug side effects section.

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

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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 headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery
• 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)

Some of these side effects can be life threatening, particularly infections. You should contact your treatment centre if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue (tiredness) 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
• Feeling or being sick in about 4 out of every 10 people (40%) but this is usually well controlled with anti sickness drugs
• 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
• Tummy (abdominal) pain
• 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. It may reduce your ability to drive or operate machinery
• 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
• Breathlessness and a cough – some people also have wheezing
• A high temperature
• Swollen ankles and legs due to a build up of fluid (oedema) in 15 out of 100 people (15%)
• Dizziness
• Headaches
• Muscle pain, weakness and aching
• Back pain
• A sore mouth
• Swelling of body tissues due to fluid build up (oedema)
• This drug may have a harmful effect on a developing baby so talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
• Breastfeeding is not advisable during nelarabine treatment because the drug may come through in the breast milk

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

• Changes in balance and coordination
• Difficulty in thinking normally – you may not be able to remember things as well as usual
• Shaking
• Low blood pressure
• Blurred vision
• Loss of taste
• Stomach pain
• Mild liver changes that are unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment finishes, but you will have regular blood tests to check how well your liver is working
• Kidney changes that are unlikely to cause symptoms – the kidneys will almost certainly go back to normal when the treatment ends, but you will have regular blood tests to check
• 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)

You won’t get all these side effects. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on

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

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a number at the hospital to call if you are worried.

Nelarabine is a relatively new drug in cancer treatment. This means that the information about side effects is based on only a few trials. And there is no information available at the moment about possible longer term effects that it may cause. Let your doctor or nurse know if you notice anything that is not normal for you.

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

You should not have immunisations with live vaccines while you are having this treatment or for at least 6 months afterwards. In the UK, live vaccines include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.