Nelarabine

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`DRUG-NELARABINE`
Type	Drug
Aliases	ArranonAtrianceНеларабін
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-T-ALL`
Sources	`SRC-ESMO-PTCL-2024` `SRC-NCCN-BCELL-2025`

Drug Facts

Class	Nucleoside analog (deoxyguanosine analog) — selectively cytotoxic for T-lymphoblasts
Mechanism	Pro-drug demethylated to ara-G (9-β-D-arabinofuranosylguanine), then phosphorylated to ara-GTP, which incorporates into DNA and inhibits DNA synthesis. T-lymphoblasts accumulate ara-GTP preferentially due to higher deoxyguanosine kinase activity, conferring T-cell selectivity.
Typical dosing	Adults: 1500 mg/m² IV over 2h on days 1, 3, 5 every 21 days. Pediatrics: 650 mg/m² IV daily × 5 every 21 days.
Ukraine registered	False
NSZU reimbursed	False
Ukraine last verified	2026-04-27

Warnings

Severe neurologic adverse reactions including peripheral neuropathy, demyelination, ascending paralysis (Guillain-Barré-like), seizures — sometimes irreversible

Notes

AALL0434 (Dunsmore 2020) — adding nelarabine to augmented BFM improved 4-yr DFS in pediatric/AYA T-ALL (88.9% vs 83.3%). Adult data: Gökbuget 2017 — nelarabine effective in r/r T-ALL/T-LBL (CR ~37%). FDA-approved for r/r T-ALL/T-LBL after ≥2 prior lines. Neurotoxicity is dominant DLT — baseline neurologic exam mandatory; permanent discontinuation if Grade ≥2 neurologic events. Often used as bridge to alloSCT in fit responders.

Used By

Indications

IND-T-ALL-1L-HYPER-CVAD - IND-T-ALL-1L-HYPER-CVAD

Regimens

REG-NELARABINE-TCELL - Nelarabine monotherapy for r/r T-ALL/T-LBL (adult dosing)