Atriance (Nelarabine)

How does it work?

Atriance infusion contains the active ingredient nelarabine, which is a type of chemotherapy medicine used to treat cancer known as a cytotoxic antimetabolite. Atriance is used to treat people with T-cell acute lymphoblastic leukaemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LBL). It works by killing the abnormal cells that cause these diseases.

The bone marrow produces cells called stem cells. These normally develop into the different types of blood cells (white blood cells, red blood cells and platelets) and when these are mature they leave the bone marrow and enter the bloodstream.

In leukaemia the bone marrow produces too many immature white blood cells. These abnormal cells take up space in the bone marrow and result in less room for production of normal healthy blood cells.

In lymphoblastic leukaemia too many immature white blood cells are found in the bone marrow and blood, and in lymphoblastic lymphoma these abnormal cells are found in the lymph system.

Nelarabine works by reducing the multiplication of the cells involved in T-ALL or T-LBL. It does this by inhibiting the production of the cells' genetic material, DNA. DNA is needed for growth and multiplication of cells. Nelarabine causes a deficiency of DNA in the cancer cells, and this causes the cells to grow in an unbalanced way, resulting in the death of the cells.

Unfortunately, nelarabine can also affect normal, healthy cells, particularly those that multiply quickly, such as blood cells and hair cells. The most important side effect is on the bone marrow where blood cells are made. Nelarabine can also temporarily decrease the production of healthy blood cells, leaving people susceptible to infection. Regular blood tests are therefore needed to monitor the levels of blood cells.

In most chemotherapy regimens, doses are administered in courses at various intervals to allow normal cells to recover from the adverse effects of the anticancer medicines between doses. However, during this period, cancer cells will also recover and start to replicate again. Successful treatment depends on the administration of the next course of therapy before the cancer cells reach their previous numbers and the net effect is to decrease the amount of cancer with each successive course.

What is it used for?

  • T-cell acute lymphoblastic leukaemia (T-ALL).
  • T-cell lymphoblastic lymphoma (T-LBL).

Atriance infusion is only used to treat people whose cancer has not responded to, or has relapsed after at least two previous chemotherapy treatments.

How is this treatment given?

  • Atriance infusion is given via a drip into a vein (intravenously) by a doctor or nurse. The drip usually lasts for about an hour for children and about two hours for adults.
  • Treatment with Atriance is given in several cycles of treatment.
  • For adults and adolescents aged 16 years and over, an infusion of Atriance is given on days one, three and five. This is then repeated every three weeks, depending on results of blood tests.
  • For children and adolescents aged 21 years and under, an infusion of Atriance is given every day for five days. This is then repeated every three weeks, depending on results of blood tests.
  • Adolescents aged 16 to 21 may be given either of these regimens - your doctor will decide which is most appropriate.


  • This medicine (as well as the disease itself) can decrease the number of healthy blood cells in your blood. A low white blood cell count can increase your susceptibility to infections; a low red blood cell count causes anaemia and a low platelet count can cause problems with blood clotting. For this reason, you will need regular blood tests to monitor your blood cells during treatment with this medicine. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, black or tarry stools, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
  • This medicine can sometimes affect the nervous system. Your doctor will monitor you for these problems. It is important to tell your doctor or nurse if you notice any of the following symptoms while having treatment, as your dose of this medicine may need reducing or your treatment interrupting: feeling very sleepy or confused, changes in sensation such as tingling, pins and needles or numbness, problems with physical coordination such as unsteadiness or balance problems when walking, seizures.
  • This medicine may be harmful to an unborn baby, and for this reason you should use effective contraception to avoid getting pregnant or fathering a child during treatment. You should continue to use contraception to prevent pregnancy for at least three months after treatment with this medicine is stopped. Women should consult their doctor immediately if they get pregnant during treatment.
  • Your ability to become pregnant or father a child may be affected by this medicine. It is important to discuss fertility with your doctor before starting treatment.
  • There is limited information available about the safety and effectiveness of this medicine in children under four years old.

Use with caution in

  • Elderly people.
  • Decreased liver function.
  • Decreased kidney function.
  • People on a low sodium diet. (Atriance infusion contains sodium).
  • People who are having or have previously had chemotherapy given into the spinal cord (intrathecally).
  • People who have previously had radiotherapy treatment to the brain or spine.

Not to be used in

  • Pregnancy.
  • Breastfeeding.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

  • This medicine should not be used in pregnancy, unless considered essential by your doctor due to life-threatening disease, because it may be harmful to a developing baby.
  • Women who could get pregnant should use effective contraception to prevent pregnancy, and men should use effective contraception to prevent fathering a child, both during treatment, and for at least three months after treatment is finished. Seek further medical advice from your doctor.
  • It is not known if this medicine passes into breast milk. Mothers who need treatment with this medicine should not breastfeed. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

  • Decrease in the number of healthy white blood cells, red blood cells or platelets in the blood (leukopenia and neutropenia, anaemia and thrombocytopenia) – see warning section above for symptoms to look out for.
  • Infections – including chest infections, urine tract infections and blood infections (sepsis).
  • Fever (high temperature).
  • Disturbances of the gut such as diarrhoea, vomiting, constipation, nausea, abdominal pain.
  • Dizziness.
  • Sleepiness.
  • Changes in sensation, such as tingling, pins and needles or numbness (see warning section above).
  • Headache.
  • Feeling weak or tired.
  • Muscle pain.
  • Swelling due to fluid retention (oedema).
  • Shortness of breath.
  • Cough.

Common (affect between 1 in 10 and 1 in 100 people)

  • Seizures.
  • Loss of memory (amnesia).
  • Feeling confused.
  • Blurred vision.
  • Sore mouth including sore and bleeding gums, inflammation of the lining of the mouth, mouth ulcers.
  • Change in sense of taste.
  • Loss of appetite.
  • Weight loss.
  • Shaky movements and unsteady walk (ataxia – see warning section above).
  • Tremor.
  • Problems with balance.
  • Muscle weakness.
  • Back pain.
  • Pain in the joints (arthralgia).
  • Pain in the extremities, eg hands and feet.
  • Wheezing.
  • Fluid in the chest cavity around the lungs (pleural effusion).
  • Low levels of potassium, calcium or magnesium in the blood (hypokalaemia, hypocalcaemia or hypomagnesaemia).
  • Low blood sugar levels.
  • Low blood pressure.
  • Elevated levels of liver enzymes.
  • Tumour lysis syndrome, where the body is unable to cope with all the waste products of the cancer cells killed by this medicine. This may lead to abnormal levels of salts in your blood and possibly kidney failure.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while being treated with this one, to make sure that the combination is safe.

Nelarabine should not be used with pentostatin, another cytotoxic medicine used in the treatment of cancer.

This medicine can decrease the body's immune response. This means that vaccines may be less effective if given during treatment, because the body does not produce sufficient antibodies. Live vaccines may cause serious infections. Live vaccines include: measles, mumps, rubella, MMR, BCG, chickenpox, oral polio, oral typhoid and yellow fever. These should not be given to people whose immune system is underactive due to treatment with this medicine.

Other medicines containing the same active ingredient

There are currently no other medicines available in the UK that contain nelarabine as the active ingredient.