Briefing Note - nelarabine (Atriance)

SMC has accepted nelarabine for the treatment of patients with T-cell acute lymphoblastic leukaemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) whose disease has not been improved or has returned following treatment with at least two chemotherapy regimens. It should only be used by specialists as a treatment to bridge to stem cell transplant.

• Leukaemia and lymphoma are both cancers involving white blood cells in the body. T-cell acute lymphoblastic leukaemia (T-ALL) is a type of leukaemia and T-cell lymphoblastic lymphoma (T-LBL) is a type of lymphoma.
• Treatment involves giving anti-cancer drugs to kill the cancer cells (this is called chemotherapy). If the cancer returns following chemotherapy, a procedure called a stem cell transplant may be used. This procedure gives patients an intensive high dose of chemotherapy (and sometimes radiotherapy) to kill the cancer cells. The patient is then given healthy cells from a donor so that the patient can make normal blood cells again.
• Treatment is necessary to allow patients to become well enough before undergoing the stem cell transplant procedure. Studies have shown that nelarabine (a drug given by a drip) can enable patients to go on to have a stem cell transplant.
• Changes in the sense of feeling in hands or feet and muscle weakness (called peripheral neuropathy) are common side effects of nelarabine.
• SMC accepted nelarabine to treat patients who would be suitable for a stem cell transplant following two unsuccessful cycles of chemotherapy because it is likely to be of similar value for money as another drug used in this way (called clofarabine).