Nelarabine-induced myelopathy in patients undergoing allogeneic hematopoietic cell transplantation: a report of three cases.
Allogeneic hematopoietic cell transplantation
Autopsy
Myelopathy
Nelarabine
T-cell acute lymphoblastic leukemia/lymphoma
Journal
International journal of hematology
ISSN: 1865-3774
Titre abrégé: Int J Hematol
Pays: Japan
ID NLM: 9111627
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
13
09
2022
accepted:
11
01
2023
revised:
11
01
2023
medline:
30
5
2023
pubmed:
28
1
2023
entrez:
27
1
2023
Statut:
ppublish
Résumé
Nelarabine is an effective treatment for T-cell acute lymphoblastic leukemia/lymphoma. Myelopathy is a rare but serious adverse event associated with this drug. Three patients who received nelarabine at the National Cancer Center Hospital from December 2014 to March 2021 developed myelopathy 20 days before, 12 days after, and 29 days after allogeneic hematopoietic cell transplantation (allo-HCT), respectively. Magnetic resonance imaging showed that two of the patients had lesions in the dorsal column or medulla oblongata, and one had no abnormalities in the head or spine. Despite treatment with intravenous immunoglobulin and methylprednisolone, all patients became unable to walk. One patient died on day 101 after allo-HCT due to progressive neurotoxicity. The other two patients showed spontaneous improvement in neurological symptoms, but one died of mucormycosis on day 476. Autopsy revealed spongiosis in the posterior funiculus in both patients who died, and also in the medulla oblongata in one patient. In the surviving patient, positron emission tomography on day 84 showed abnormal accumulation, suggesting continued inflammation. These cases demonstrated pathophysiological features of nelarabine-induced myelopathy and indicate that allo-HCT may worsen the condition. It is necessary to elucidate the underlying mechanism and establish diagnostic methods and therapies.
Identifiants
pubmed: 36705847
doi: 10.1007/s12185-023-03539-5
pii: 10.1007/s12185-023-03539-5
doi:
Substances chimiques
nelarabine
60158CV180
Arabinonucleosides
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
933-940Subventions
Organisme : The National Cancer Center Research and Development Fund
ID : 2020-A-15
Informations de copyright
© 2023. Japanese Society of Hematology.
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