Nelarabine

INTRODUCTION

Indications

T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma unresponsive to at least 2 other previous chemotherapy regimens.

Action

Converted intracellularly to arabinosylguanine (ara-G) and then to arabinosylguanine triphosphate (ara-GTP). In leukemic cells, it is incorporated into DNA, leading to inhibition of DNA synthesis and cell death.Therapeutic Effects: Decreased proliferation of leukemic cells.

Adverse Reactions/Side Effects

Hemat: anemia, leukopenia, neutropenia, thrombocytopenia. Neuro: SEVERE NEUROLOGIC EVENTS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of CNS neurotoxicity, including confusion, agitation, severe headache, hearing loss, visual disturbances, decreased consciousness, and seizures. Notify physician immediately, especially if patient becomes unresponsive or difficult to arouse.

• Monitor signs of leukopenia and neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or anemia (unusual weakness, fatigue, shortness of breath, pallor). Report these signs to the physician.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to maintain muscle strength and aerobic capacity during cancer chemotherapy or to help restore function after chemotherapy.

Patient/Client-Related Instruction

• Advise patient to decrease risk of infections (frequent hand washing, etc.) and to avoid contact with persons with contagious diseases.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability. Intracellular conversion is required for activation of prodrug.

Distribution: Extensively distributed.

Metabolism and Excretion: Mostly metabolized intracellularly. Partially eliminated by the kidneys as nelarabine and ara-G.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; CCr <50 mL/min; OB: Pregnancy, lactation.

Use Cautiously in: OB: Patients with childbearing potential; Geri: Risk of neurologic events may be ↑; Severe hepatic impairment (bilirubin >3.0 mg/dL).

Interactions

Drug-Drug: Decreases antibody response to and ↑ risk of adverse reactions from live-virus vaccines.

Route/Dosage

IV (Adults): 1500 mg/m² on days 1, 3, and 5 of every 21-day cycle.

IV (Children): 650 mg/m²/day for first 5 days of every 21-day cycle.

Availability

Solution for IV injection: 5 mg/mL in 50-mL vials (250 mg/vial).