Last reviewed 2026-04-20 · How we verify

Arranon (NELARABINE)

Arranon works by inhibiting the enzyme responsible for converting nucleosides into their active forms, thereby preventing DNA synthesis in cancer cells.

Arranon (Nelarabine) is a small molecule nucleoside metabolic inhibitor developed by Novartis and currently owned by Sandoz. It is used to treat precursor T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia. Arranon works by inhibiting DNA synthesis, thereby preventing cancer cell growth. The drug is off-patent and has multiple generic manufacturers. Key safety considerations include its short half-life and low bioavailability.

At a glance

Mechanism of action

Nelarabine is prodrug of the deoxyguanosine analogue 9--D-arabinofuranosylguanine (ara-G), nucleoside metabolic inhibitor. Nelarabine is demethylated by adenosine deaminase (ADA) to ara-G, mono-phosphorylated by deoxyguanosine kinase and deoxycytidine kinase, and subsequently converted to the active 5-triphosphate, ara-GTP. Accumulation of ara-GTP in leukemic blasts allows for incorporation into deoxyribonucleic acid (DNA), leading to inhibition of DNA synthesis and cell death. Other mechanisms may contribute to the cytotoxic and systemic toxicity of nelarabine.

Approved indications

• Precursor T-cell lymphoblastic lymphoma
• T-cell acute lymphoblastic leukemia

Boxed warnings

• WARNING: NEUROLOGIC ADVERSE REACTIONS See full prescribing information for complete boxed warning. Severe neurologic adverse reactions have been reported with the use of nelarabine injection. These adverse reactions have included altered mental states including severe somnolence, central nervous system effects including convulsions, and peripheral neuropathy ranging from numbness and paresthesias to motor weakness and paralysis. There have also been reports of adverse reactions associated with demyelination, and ascending peripheral neuropathies similar in appearance to Guillain-Barré syndrome. ( 5.1 ) Full recovery from these adverse reactions has not always occurred with cessation of therapy with nelarabine injection. Monitor frequently for signs and symptoms of neurologic toxicity. Discontinue nelarabine injection for neurologic adverse reactions of NCI Common Toxicity Criteria for Adverse Events (CTCAE) Grade 2 or greater. ( 5.1 ) WARNING: NEUROLOGIC ADVERSE REACTIONS Severe neurologic adverse reactions have been reported with the use of Nelarabine injection. These adverse reactions have included altered mental states including severe somnolence, central nervous system effects including convulsions, and peripheral neuropathy ranging from numbness and paresthesias to motor weakness and paralysis. There have also been reports of adverse reactions associated with demyelination, and ascending peripheral neuropathies similar in appearance to Guillain-Barré syndrome [see Warnings and Precautions ( 5.1 )] . Full recovery from these adverse reactions has not always occurred with cessation of therapy with nelarabine injection. Monitor frequently for signs and symptoms of neurologic toxicity during treatment with nelarabine injection. Discontinue nelarabine injection for neurologic adverse reactions of NCI Common Toxicity Criteria for Adverse Events (CTCAE) Grade 2 or greater [see Warnings and Precautions ( 5.1 )] .

Common side effects

• Anemia
• Thrombocytopenia
• Neutropenia
• Fatigue
• Pyrexia
• Cough
• Dyspnea
• Nausea
• Diarrhea
• Vomiting
• Constipation
• Somnolence

Drug interactions

• pentostatin

Key clinical trials

• CApivasertib, Venetoclax And Low-intensity chemotheRapY for Adults With ALL/LBL (PHASE1,PHASE2)
• Adding Dasatinib Or Venetoclax To Improve Responses In Children With Newly Diagnosed T-Cell Acute Lymphoblastic Leukemia (ALL) Or Lymphoma (T-LLY) Or Mixed Phenotype Acute Leukemia (MPAL) (PHASE2)
• Treatment of Newly Diagnosed Acute Lymphoblastic Leukemia in Children and Adolescents (PHASE3)
• Low-Intensity Chemotherapy and Venetoclax in Treating Patients With Relapsed or Refractory B- or T-Cell Acute Lymphoblastic Leukemia (PHASE1,PHASE2)
• Combination Chemotherapy and Nelarabine in Treating Patients With T-cell Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma (PHASE2)
• Testing the Addition of Daratumumab to Chemotherapy for Treating Patients With Newly-Diagnosed T-Cell Lymphoblastic Leukemia (T-ALL) and T-Cell Lymphoblastic Lymphoma (T-LL) (PHASE2,PHASE3)
• Optimization of Therapy in Adult Patients With Newly Diagnosed Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma by Individualised, Targeted and Intensified Treatment (PHASE3)
• Total Therapy XVII for Newly Diagnosed Patients With Acute Lymphoblastic Leukemia and Lymphoma (PHASE2,PHASE3)

Primary sources

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Competitive intelligence

For the full competitive landscape — auto-detected comparators, recent regulatory actions across the set, upcoming PDUFA, patent timeline, sponsor landscape:

• Arranon CI brief — competitive landscape report
• Arranon updates RSS · CI watch RSS
• Novartis portfolio CI