Nelarabine (Atriance) is a nucleoside metabolism inhibitor. It is used to treat T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) in patients who have no response to at least two chemotherapy regimens or experience disease recurrence.

How to Use Nelarabine (Atriance)

Routine Dosing Regimens

Adult Dosage: 1500mg/m² administered via intravenous infusion over 2 hours, given on Days 1, 3, and 5, and repeated every 21 days.

Pediatric Dosage (≥ 1 year old): 650mg/m² administered via intravenous infusion over 1 hour, given consecutively for 5 days, and repeated every 21 days.

Administration Requirements

For intravenous use only; administration without dilution is not allowed.

The duration of treatment should be adjusted individually based on disease progression, toxic reactions, or the need for hematopoietic stem cell transplantation.

Dosage Adjustment of Nelarabine (Atriance)

Neurotoxicity

Grade ≥ 2 Neurotoxicity (per CTCAE criteria): Discontinue the drug immediately. Symptoms include paresthesia, motor weakness, ataxia, or disturbance of consciousness.

Monitoring Requirements: Closely monitor neurological symptoms during treatment and for at least 24 hours after treatment completion.

Hematologic Toxicity

If neutrophils < 1.0×10⁹/L or platelets < 50×10⁹/L: Delay administration until counts recover.

Other Toxicities

Pancreatitis or abnormal liver enzymes (Grade ≥ 3): Suspend administration and assess whether to reduce the dose after recovery.

Tumor Lysis Syndrome: Prophylactic hydration, urine alkalinization, and allopurinol administration are required.

Nelarabine (Atriance) Use in Special Populations

Patients with Renal Impairment

Creatinine Clearance (CLCr) ≥ 50mL/min: No dosage adjustment is needed.

CLCr 30-50mL/min or < 30mL/min: Closely monitor for toxicity; there is no clear recommended dosage.

Patients with Hepatic Impairment

Severe Hepatic Impairment (bilirubin > 3×ULN): Closely monitor for toxicity; there is no clear recommendation for dosage adjustment.

Pregnancy and Lactation

Pregnant Women: Classified as Pregnancy Category D. It may cause fetal malformations, so effective contraception is required.

Lactation: Breastfeeding is prohibited.

Pediatric and Geriatric Patients

Pediatric Patients (≥ 1 year old): Efficacy has been established, and the incidence of neurotoxicity is lower than that in adults.

Geriatric Patients (≥ 65 years old): May have an increased risk of neurotoxicity, and renal function should be evaluated.