Nelarabine (Arranon®)

How to Take Nelarabine

Nelarabine is given through intravenous (IV, into a vein) infusion. The dose is based on your weight. Your provider will decide how often you should receive this medication. You may be given additional intravenous fluids and medications to protect your kidneys prior to the infusion.

Nelarabine may interact with other medications, such as pentostatin, which is an adenosine deaminase inhibitor. Make sure that you tell your provider about all of the medications, vitamins, and supplements you are taking.

You, or anyone you live with, should avoid having live or live-attenuated vaccines while receiving this medication. These include herpes zoster (Zostavax) for shingles prevention, oral polio, measles, nasal flu vaccine (FluMist®), rotavirus, and yellow fever vaccines.

Possible Side Effects

There are a number of things you can do to manage the side effects of nelarabine. Talk to your provider about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Neurological Disorders

Severe neurologic reactions have been linked to nelarabine. Nelarabine can cause somnolence (extreme drowsiness), dizziness, headaches, confusion, seizures, and severe peripheral neuropathy (ranging from numbness to muscle weakness and paralysis). These side effects can be so severe that they can lead to coma and paralysis. If you are experiencing any of these symptoms, call your provider right away. Due to these side effects, you should not operate machinery or drive a car while receiving therapy. 

Peripheral Neuropathy (Numbness or Tingling in the Hands and/or Feet)

Peripheral neuropathy is a toxicity that affects the nerves. It causes numbness or a tingling feeling in the hands and/or feet, often in the pattern of a stocking or glove. This can get progressively worse with additional doses of the medication. In some people, the symptoms slowly resolve after the medication is stopped, but for some, it never goes away completely. Tell your provider if you have numbness or tingling in your hands and/or feet, as they may need to adjust the dose of your medication.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. Let your provider know if you have any shortness of breath, difficulty breathing, or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the count is low, you are at a higher risk of bleeding. Let your provider know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), etc. as these can all increase the risk of bleeding. Talk with your provider about the use of all over-the-counter medications/supplements while on therapy.
• Do not floss or use toothpicks. Use a soft-bristle toothbrush to brush your teeth.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. Let your provider know right away if you have a fever (temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever, or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bathe daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your provider before scheduling dental appointments or procedures.
• Ask your provider before you, or someone you live with has any vaccinations.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your provider for helpful tips on dealing with this side effect.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary for males and females during treatment. Males should also use condoms for 3 months after treatment has ended, including those who have had vasectomies. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while receiving this medication.