Nelarabine-associated reversible Guillain-Barré-like syndrome or myelopathy in an grownup affected person with major refractory T-lymphoblastic lymphoma.
Curr Probl Most cancers. 2017 Mar – Apr;41(2):138-143
Authors: Lalayanni C, Baldoumi E, Papayiannopoulos S, Tziola Ok, Saloum R, Anagnostopoulos A
Nelarabine is a purine analogue used for the remedy of sufferers with relapsed or refractory T-cell acute lymphoblastic leukemia and T-cell lymphoblastic lymphoma primarily as a bridge to stem cell transplantation. The water-soluble prodrug of 9-beta-D-arabinofuranosyl guanine (Ara-G) is phosphorylated inside leukemic cells to type ara-G triphosphate (ara-GTP), which terminates DNA chain elongation, leading to cell demise. The drug obtained accelerated approval by the US Meals and Drug Administration (FDA) on October 2005 primarily based on the induction of full remissions in 2 part II trials. In these trials, neurologic toxicity was primarily introduced as peripheral neuropathy and, since, is a generally reported facet impact of the drug. Nonetheless, circumstances of extreme grade III, IV, and even deadly neurotoxicity in addition to circumstances of ascending myelopathy have additionally been reported with most of those circumstances being irreversible. On this article, we report a reversible grade IV Guillain-Barré-like case of a affected person with major refractory T-cell lymphoblastic lymphoma handled with nelarabine. Guillain-Barré-like syndrome on this affected person coexisted with poisonous myelopathy which affected the entire backbone. The pathogenetic mechanisms and genetic predisposition for nelarabine-associated neurotoxicity remains to be unknown. The position of the immune system and the affected person’s genetic background are underneath investigation together with issues on the suitable remedy of the syndrome. Gaining a greater understanding within the contributing mechanisms will assist us to acknowledge people at risk for neurotoxicity and can result in the immediate remedy of this complication. But, it may be concluded from the current case and literature evaluation that high-dose cytarabine regimens and intrathecal installations must be prevented in shut time proximity with nelarabine remedy, as they may improve neurotoxicity.
PMID: 28169005 [PubMed – indexed for MEDLINE]