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About ARRANON
Clinical Data and Efficacy [1]
The safety and efficacy of ARRANON were evaluated in two open-label, single-arm, multicenter studies.
One of these studied pediatric patients and the other studied adult patients. In both studies, complete response (CR) was defined as bone marrow blast counts ≤5%, no other evidence of disease, and full recovery of peripheral blood counts. Complete response without full hematologic recovery (CR*) was also assessed. In addition, patients who experienced signs or symptoms of grade 2 or greater neurologic toxicity on therapy in either study were to be discontinued from further therapy with ARRANON.
Pediatric Clinical Study: Remission in 23% of Patients and Median Overall Survival of 13 Weeks
This study included patients 21 years of age and younger, who had relapsed or refractory T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LBL). Eighty-four patients, 39 of whom had received two or more prior induction regimens and 31 of whom had received 1 prior induction, were treated with 650 mg/m²/day of ARRANON, administered intravenously over 1 hour daily for 5 consecutive days, repeated every 21 days.
The 84 patients ranged in age from 2.5 years to 21.7 years (overall mean, 11.9 years), 52% were 3 years to 12 years of age and most were male (74%) and Caucasian (62%). The majority (77%) of patients had a diagnosis of T-ALL. Efficacy results are presented below.
Table 1. Efficacy Results in Patients 21 Years of Age and Younger at Diagnosis With ≥2 Prior Inductions; Treated with 650 mg/m² of ARRANON Administered Intravenously Over 1 Hour Daily for 5 Consecutive Days, Repeated Every 21 Days

| N = 39 |
 |
| CR plus CR* % (n) [95% CI] |
23% (9) [11%, 39%] |
 |
| CR % (n) [95% CI] |
13% (5) [4%, 27%] |
 |
| CR* % (n) [95% CI] |
10% (4) [3%, 24%] |
 |
| Duration of CR plus CR* (range in weeks)† |
3.3 to 9.3 |
 |
| Median overall survival (weeks) [95% CI] |
13.1 [8.7, 17.4] |
|
CR=complete response.
CR*=complete response without hematologic recovery.
†Does not include 5 patients who were transplanted or had subsequent systemic
chemotherapy (duration of response in these 5 patients was 4.7 to 42.1 weeks).
The mean number of days on therapy was 46 days (range of 7 days to 129 days). Median time to CR plus CR* was 3.4 weeks (95% CI: 3.0, 3.7).
Adult Clinical Study: Remission in 21% of Patients and a Median Overall Survival of 21 Weeks
This study included 39 treated patients, 28 of whom had T-cell acute lymphoblastic leukemia (T-ALL) or T-cell lymphoblastic lymphoma (T-LBL) and who had relapsed following or were refractory to at least two prior induction regimens, and 11 of whom had relapsed following or were refractory to 1 prior induction. ARRANON 1,500 mg/m² was administered intravenously over 2 hours on days 1, 3, and 5, repeated every 21 days.
Seventeen patients had a diagnosis of T-ALL and 11 had a diagnosis of T-LBL. For patients with ≥2 prior inductions, the age range was 16 years to 65 years (mean 34 years) and most patients were male (82%) and Caucasian (61%). Patients with central nervous system (CNS) disease were not eligible. The results of the study for patients who had received ≥2 prior inductions are shown in Table 2.
Table 2. Efficacy Results in Adult Patients With ≥2 Prior Inductions; Treated with 1,500 mg/m² of ARRANON Administered Intravenously Over 2 Hours on Days 1, 3, and 5, Repeated Every 21 Days

| N = 28 |
 |
| CR plus CR* % (n) [95% CI] |
21% (6) [8%, 41%] |
 |
| CR % (n) [95% CI] |
18% (5) [6%, 37%] |
 |
| CR* % (n) [95% CI] |
4% (1) [0%, 18%] |
 |
| Duration of CR plus CR* (range in weeks)† |
4 to 195+ |
 |
| Median overall survival (weeks) [95% CI] |
20.6 weeks [10.4, 36.4] |
|
CR=complete response.
CR*=complete response without hematologic recovery.
†Does not include 1 patient who was transplanted (duration of response was 156+ weeks).
The mean number of days on therapy was 56 days (range of 10 days to 136 days). Time to CR plus CR* ranged from 2.9 weeks to 11.7 weeks.
Indication
ARRANON is indicated for the treatment of patients with T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL) whose disease has not responded to or has relapsed following treatment with at least two chemotherapy regimens. This use is based on the induction of complete responses. Randomized trials demonstrating increased survival or other clinical benefit have not been conducted.

Important Safety Information
ARRANON® (nelarabine) injection should be administered under the supervision of a physician experienced in the use of cancer chemotherapeutic agents. This product is for intravenous use only.

Neurologic Events: Severe neurologic events have been reported with the use of ARRANON. These events 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 events associated with demyelination, and ascending peripheral neuropathies similar in appearance to Guillain-Barré syndrome.

Full recovery from these events has not always occurred with cessation of therapy with ARRANON. Close monitoring for neurologic events is strongly recommended, and ARRANON should be discontinued for neurologic events of NCI Common Toxicity Criteria grade 2 or greater.

In clinical studies of ARRANON, hematologic toxicity was the most common grade 3 (moderate) or 4 (severe) adverse event. For a complete list and incidence of adverse events: pediatric patients; adult patients. Hematologic toxicity included neutropenia, thrombocytopenia, anemia, febrile neutropenia, or neutropenia with infection.

Other common toxicities included laboratory abnormalities including increased transaminases, gastrointestinal toxicity, fatigue, and asthenia.

Patients treated previously or concurrently with intrathecal chemotherapy or previously with craniospinal irradiation may be at increased risk for neurologic adverse events.

Women of child-bearing potential should be advised to avoid becoming pregnant while receiving treatment with ARRANON.

Appropriate measures (e.g., hydration, urine alkalinization, and prophylaxis with allopurinol) must be taken to prevent hyperuricemia of tumor lysis syndrome.

Nursing should be discontinued in women who are receiving therapy with ARRANON.

Because the risk of adverse reactions to this drug may be greater in patients with severe renal impairment (CLcr <30 mL/min), these patients should be closely monitored for toxicities when treated with ARRANON.

Because the risk of adverse reactions to this drug may be greater in patients with severe hepatic impairment (bilirubin >3.0 mg/dL), these patients should be closely monitored for toxicities when treated with ARRANON.
Prescribing Information for ARRANON | Important Safety Information | Patient Information Leaflet

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