Leukemia /Lymphoma

Most common adverse reactions in children regardless of causuality were-
hematologic disorders eg anemia, leukopenia, neutropenia, thrombocytopenia.

Of the non-hematologic adverse reactions in children - most frequent are-
headache, increased transaminase levels, decreased potassium, decreased albumin,
increased blood bilirubin and vomiting

Most common advere reactions in adults-
GI disorders eg constipation, diarrhea, nausea, vomiting,
hemotologic disoders, eg.anemia neutropenia, thrombocytopenia,
respiratory disorders eg cough, dyspnea
nervous system disorders - eg somnolence, dizziness, and pyrexia
 
Most common in children

Hematologic - anemia  40%  leucopenia  12% neutropenia 15%   thrombocytopenia 25%

Hepatic - blood albumin decreased 4%   blod bilirubin increased 5% 
                 transaminase increased  3%

Most common in adults-

CNS -  Fatigue   8% 

Hematologic - anemia   16%   febrile neutropenia    7%   neutropenia  12%
                          thrombocytopenia   34%

Nelarabine is contraindicated in patients with a history of hypersensitivity to nelarabine

Special Precautions /Warnings

Neurologic  effects - nelarabine is a potent antineoplastic agent with potentially significant
toxic side effects. Neutrotoxicity is the dose limiting toxicity to nelarabine.
Closely observe patients for signs and symptoms of neurologic toxicity.

IV hydration-  patients receiving nelarabine should receive IV hydration.
Consider use of allopurinol inpatients at risk of hyperuricemia.

Immunocompromised patients - avoid administration of live vaccines to immunocompromised patients

Renal function impairment - closely monitor for toxicites when treated with nelarabine

Hepatic function impairment - closely monitor for toxicites when treated with nelarabine

Hazardous tasks - caution  patients receiving nelarabine therapy about operating hazardous machinery , because they may experience somnolence 

Pregnancy - advice women of child bearing age to avoid becoming pregnant while receiving treatment wih  nelarabine

Lactation-  discontinue breast feeding in women who are receiving nelarabine

Children- follow doctors advice

Elderly - decreased renal response are more common in the elderly

Monitoring- regularly monitor complete blood counts, including platelets 

Indication-

Leukemia /Lymphoma

Dosage-

Adults- recommended adult dose of nelarabine is 1500mg/m2  administered IV over 2 hours on day 1 ,3, and 5 repeated every 21 days. Nelabarine is administered undiluted

Children - recommended pediatric dose of nelarabine is 650mg/m2 administrered  IV over 2 hours for 5 consecutive days, repeated every 21 days. nelarabine is administered undiluted.

Supportive measures - appropiate measures eg hydration, urine alkalisation, must be taken to prevent hyperuricemia of tumor lysis syndrome. 

Storage- store at 25C ( 77F ) ,excursions permitted to 15C to 30C ( 59 to 86F)

1. Because patients receiving nelarabine therapy may experience somnolence , caution, them  about operating hazardous machinery. 

1. Instruct patiients to contact their physician if they experience new or worsening of symptoms  of peripheral neuropathy. including, tingling, or numbness of fingers, hands, toes,  unsteadiness while walking, weakness arising from low chair, weakness while climbing    chairs, increased tripping while walking over uneven surfaces.

3. Instruct patients that seizures have known to occur in patients receiving nelarabine. Report  to your doctor, if seizure occurs

4. Patients who develop fever or signs of infection while on therapy , should notify their
    physician immediately

5. Advice patients to use contraceptive measures to prevent pregnancy and to avoid
    breast feeding during treatment, with nelarabine.

Pregnancy -
Advice women of child bearing age to avoid becoming pregnant while receiving
treatment wih  nelarabine

Lactation- 
Discontinue breast feeding in women who are receiving nelarabine

Children-
Follow doctors advice

Elderly -
Decreased renal response are more common in the elderly