In its Final Appraisal Report, the All Wales Medicines Strategy Group (AWMSG) has supported the restricted use within NHS Wales of nelarabine (Atriance®) for the treatment of patients with T-cell acute lymphoblastic leukaemia and T-cell lymphoblastic lymphoma, whose disease has not responded to, or has relapsed, following treatment with at least two chemotherapy regimens. Treatment should be restricted to patients in whom there is an intention to proceed to allogeneic stem cell transplantation, as it is not cost effective when used for palliation. This treatment is not suitable for shared care within NHS Wales.