Nelarabine
Nelarabine is an antineoplastic medication classified as a nucleoside metabolic inhibitor used primarily to treat certain blood cancers. It is a prodrug that is converted to its active form (ara-G) within the body to target and inhibit the growth of cancerous T-cells.
Nelarabine is a nucleoside metabolic inhibitor prodrug used to treat relapsed or refractory T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- L01BB07
- RxNorm
- 274771
- Generic
- Nelarabine
- Class
- atc-l01
- Brands
- Arranon
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 1500 mg/m²
- Maximum
- consult physician
- Frequency
- on days 1, 3, and 5 (or days 1, 8, and 15)
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 650 mg/m²
- Maximum
- consult physician
- Frequency
- on days 1 through 5
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 1500 mg/m²
- Maximum
- consult physician
- Frequency
- per adult protocol with monitoring
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
8 groupspregnancy
first trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks to the fetus
regular fetal monitoring and ultrasound examinations
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
third trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks; consider alternative therapy
fetal monitoring, non-stress tests, biophysical profiles
Use of this medication in this population requires careful consideration of risks and benefits.
pediatric_age
children 1 18 yearsweight-based dosing
approved for pediatric patients with T-cell acute lymphoblastic leukemia or T-cell lymphoblastic lymphoma who have not responded to or have relapsed after at least two prior chemotherapy regimens
close hematologic monitoring, neurological assessments, liver function tests
geriatric
elderly 65 years and olderno specific dose adjustment required but monitor closely
use with caution due to potential decreased organ function; no specific dose reduction recommended based on age alone
regular monitoring of renal function, hepatic function, hematologic parameters, and neurological status
Use with caution and monitor for adverse effects.
renal_impairment
mild to moderateno dose adjustment required
no specific dose adjustment needed for mild to moderate renal impairment; monitor renal function during treatment
monitor renal function (creatinine clearance, serum creatinine) regularly
Use with caution and monitor for adverse effects.
renal_impairment
severereduce dose or increase dosing interval
use with caution in severe renal impairment; consider dose reduction or extended dosing intervals
frequent monitoring of renal function, hematologic parameters, and for signs of neurotoxicity
Use with caution and monitor for adverse effects.
hepatic_impairment
mild to moderateno specific dose adjustment required
no specific dose adjustment recommended for mild to moderate hepatic impairment; use with caution
monitor hepatic function (ALT, AST, bilirubin) regularly
Use with caution and monitor for adverse effects.
lactation
breastfeedingdiscontinue breastfeeding
discontinue breastfeeding during treatment and for at least 48 hours after last dose due to potential serious adverse reactions in nursing infants
no specific monitoring required for infant but breastfeeding should be avoided
Use of this medication in this population requires careful consideration of risks and benefits.
Statistics and clinical data
FDA approval year
FDA approval for Nelarabine (Arranon) for treatment of T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma
Drug class
Antineoplastic agent classification
Primary indications
Approved therapeutic indications
Mechanism of action
Molecular mechanism of action
Nelarabine is indicated for the treatment of patients with T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) who have not responded to or have relapsed after at least two prior chemotherapy regimens.
Nelarabine is a prodrug of 9-β-D-arabinofuranosylguanine (ara-G). Once administered, it is demethylated by adenosine deaminase (ADA) to ara-G, which is then phosphorylated by deoxyguanosine kinase and deoxycytidine kinase. The resulting active metabolites interfere with DNA synthesis in rapidly dividing cells, particularly affecting malignant T-cells.
Nelarabine carries a risk of serious neurological toxicity including seizures, paralysis, and peripheral neuropathy. It should be administered under the supervision of a qualified oncologist in a hospital setting with appropriate monitoring capabilities. Use with caution in patients with impaired renal or hepatic function.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy