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Nelarabine is a purine nucleoside analog that is used as a cytotoxic agent in hematological malignancies.1 Nelarabine is converted into arabinosyl-guanine (ara-G) in the blood, and ara-G is selectively accumulated in T cells and malignant T-lymphoid cells, where it is phosphorylated to produce ara-GTP and incorporated into DNA.2,3 This leads to DNA breaks, increased expression of Fas ligand, and apoptosis.1,3 Ara-G is accumulated most effectively by acute lymphoid leukemia and chronic myeloid leukemia blasts.1
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1. Current status of older and new purine nucleoside analogues in the treatment of lymphoproliferative diseases. Molecules 14(3), 1183-1226 (2009).
2. Arabinosylguanine is phosphorylated by both cytoplasmic deoxycytidine kinase and mitochondrial deoxyguanosine kinase. Cancer Res. 62(11), 3100-3105 (2002).
3. Mechanisms for T-