Nelarabine launched for T-cell leukaemia and lymphoma
Patients with T-cell acute lymphoblastic leukaemia and T-cell acute lymphoblastic lymphoma who have not responded to or have relapsed following two chemotherapy regimens can now be treated with nelarabine, available this week from GlaxoSmithKline.
Marketed as Atriance, nelarabine is a pro-drug of the deoxyguanosine
analogue ara-G, which is subsequently metabolised to the active ara-GTP
form. Accumulation of ara-GTP in leukaemic blast cells leads to inhibition
of DNA synthesis and cell death. According to GSK, nelarabine has been
found to have a higher potency and selectivity for T-cells than for other
blood cell types.
The recommended dose for adults is 1,500mg/m2 infused over two hours
on days 1, 3 and 5 and repeated every 21 days, and for children, 650mg/m2 infused over one hour on days 1 to 5 and repeated every 21 days. Patients
from 16 to 21 years of age have received either regimen in clinical studies,
with similar efficacy and safety — the treating clinician should
decide which regimen is the most appropriate for a patient in this age
group.
Severe neurological effects have been reported with nelarabine treatment,
ranging from numbness and somnolence to convulsions and paralysis. Events
associated with demyelination and ascending peripheral neuropathies similar
in appearance to Guillain-Barré syndrome have also been reported.
GSK recommends close monitoring for signs of neurological events.
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