Arranon is provided by the nurse using intravenous (IV) infusion at the center. The dosage and administration time can differ based on a number of factors like the condition of the patient, their age, weight, etc
General Guidelines for Use:
- Administration: Arranon administration is performed only in a hospital setting by qualified health care personnel. The infusion is usually administered once daily for a number of days during a treatment course
- Treatment Cycles: The usual practice is to give one cycle every 21 days and the length of treatment is determined by the tolerance of the patient to therapy and associated side effects.
• Pre-Treatment Assessment: Prior to being started on Arranon, patients should have a full examination including blood work to evaluate renal and hepatic function as well as baseline neurologic status.
Arranon inhibits the process of DNA replication that is required for cancer cell proliferation.
- Inhibition of Synthesis of DNA: Metabolite Built by Cancer Drug Nelson Arbiter ara-G Gets Inotolated Modified DNA In Infusion Of Dividing T Cells Common In Leukaemia And Lymphoma. Incorporation of this into the dna causes defective strands thus no further division of the cell occurs
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- Targeting of T Cells Only: Less than typical nelarabine does not spare other cells, however its greatest and most welcome impact is on T cells, making it an excellent weapon in the war against T-ALL and T-LBL.
• Induction of Apoptosis: The perturbation on the process of developing new DNA and the consequent effect on the DNA of cancerous cells encourages the process of cell death more aptly known as programmed cell death. This eventually leads to the reduction or total extinction of the tumor mass.
As with subsequent chemotherapeutic agents, so does Arranon induce a level of side effects on patients. Adverse Reactions:
- Neurological Effects– One of the most profound adverse effects of Arranon is the neurological toxicity that it may cause. These include, among others:
o Peripheral neuropath; numbness, tingling or weakness of the hands and feet
o Seizures
- Bone Marrow Suppression: Similar to other antineoplastic agents, Arranon administration may also lead to suppression of the bone marrow resulting in the wit drawl of red blood cells, white cells and platelets. Hence patients may present with;
o Lithemia
o Spontaneous bleeding or bruises (related to decreased number of Platelets)
The use of Arranon in some patients must be tempered with the proper measures, especially those suffering from any neurological ailment or any condition that compromises their immunity.
- Neurology: The use of Arranon may be associated with various severe neurological complications of which seizures, delirium and peripheral neuropathy are examples. Neurological effects must be observed very keenly and if it’s too severe treatment must be stopped.
- Liver and Kidney Function: Since it is known that Arranon causes some adverse effect on the liver and kidneys patients with such preexisting conditions should use this drug with care. Usually, liver function tests are advised.
• Infection Risk: There is likely an increased threat of infection to patients receiving Arranon as it suppresses their immunity. Infection has to be suspected and look for fever, chills, cough and so on.
Other Chemotherapy Agents:
Arranon, when used in combination with other chemotherapy drugs, may increase the risk of myelosuppression (bone marrow suppression). This results in neutropenia, anemia, and thrombocytopenia. Blood counts must be monitored closely.
When cyclophosphamide or methotrexate is administered in combination with Arranon, the immune system may be further suppressed, leading to an increased risk of infections.
Allopurinol:
Allopurinol, which is used to avoid gout, may decrease the metabolism of Arranon, so that plasma concentration of nelarabine can be increased which may lead to increased risk of toxicity.
Other Immunosuppressants
Combination with other immunosuppressive agents may increase infections and other toxicities because the immune system can be suppressed with these drugs. Corticosteroids
Chemotherapy is frequently combined with the use of corticosteroids. Corticosteroids augment the side effects of Arranon, such as hyperglycemia and fluid retention.
The dosage of Arranon differs depending on the individual’s body weight and other elements, however, the typical initial dose for adults and children above 20kg is 1500 mg/m² given as an intravenous infusion over 1 hour on day 1, day 3 and day 5 of every 21 day treatment regime.
Dosage titration is usually after assessment of treatment effect of the patient and occurrence of any adverse effects. For the most part, 2 – 3 cycles of treatment are given or, longer based on the patient’s condition and response to treatment.
Arranon is classified as a controlled medicine and it is recommended that it only be given to patients in a clinical setup by qualified personnel.
Due to the risk of serious but rare side effects, especially neurological toxicity, it is vital that this medication is only provided to patients in an oncology unit for cancer chemotherapy.
Also, patient assessment to rule out and identify any other possible conditions must be done on all patients before a decision to start treating with Arranon is made to ascertain the need for this medication and its tolerability by a such patient.