# Nelarabine

Source: https://onco.cc/drugs/nelarabine/  
OnCo record `nelarabine` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Nelarabine (Arranon) is an infusion for T-cell acute lymphoblastic leukaemia and lymphoma that has come back after at least two other treatments; it is now also added to first-line therapy for children with T-cell leukaemia.

## Summary

Nelarabine received accelerated FDA approval in October 2005 for T-cell acute lymphoblastic leukaemia and T-cell lymphoblastic lymphoma that has not responded to or has relapsed after at least two chemotherapy regimens, on phase 2 studies in adults (complete remission in about a fifth) and children; the EU authorised Atriance in 2007. The Children's Oncology Group AALL0434 trial later showed that adding nelarabine to frontline therapy improved disease-free survival in newly diagnosed T-ALL, and it is now standard in paediatric protocols. Neurotoxicity, including somnolence, peripheral neuropathy and Guillain-Barre-like demyelination, carries a boxed warning.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-10
- Also known as: Atriance
- Tags: nci-list
- Brand: Arranon
- Modality: Purine nucleoside prodrug (antimetabolite)
- Mechanism: Demethylated by adenosine deaminase to ara-G, which accumulates as ara-GTP preferentially in T lymphoblasts and is incorporated into DNA, blocking synthesis.
- Approvals: US 2005: Relapsed or refractory T-ALL and T-LBL after at least two regimens (accelerated); EU 2007: T-ALL and T-LBL after at least two regimens (Atriance)

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Nelarabine
- US label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=nelarabine
- NCI drug page: https://www.cancer.gov/about-cancer/treatment/drugs/nelarabine
- EPAR (Atriance): https://www.ema.europa.eu/en/medicines/human/EPAR/atriance

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/), [Relapsed and refractory acute lymphoblastic leukaemia in children](https://onco.cc/cancers/all-paediatric-relapsed/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- companies: [Novartis](https://onco.cc/companies/novartis/), [Sandoz](https://onco.cc/companies/sandoz/)
- key papers: [AALL0434: nelarabine in newly diagnosed T-cell acute lymphoblastic leukaemia in children and young adults](https://onco.cc/key-papers/paper-aall0434-nelarabine-t-all-dunsmore-jco-2020/)
- targets: [DNA polymerase alpha (POLA1)](https://onco.cc/targets/pola1/)
- trials: [COG AALL0434](https://onco.cc/trials/aall0434/)

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