ClinicaI Reversible Myelopathy in T-Cell Lymphoblastic Lymphoma Treated with Nelarabine and Radiotherapy: Report of a Case and Review of Literature of an Increasing Complication

Abstract

Eleven cases of neurological defects in T-ALL patients treated with nelarabine have been described in the last 4 years, seven of these after stem cell transplantation (SCT) for T Lymphoblastic Lymphoma (T-LBL). Most of these patients had an unfavorable outcome or irreversible neurological damage. We now report the case of a 41-year-old woman suffering from T-LBL who presented with severe, but reversible myelopathy after receiving nelarabine-based treatment and mediastinal radiotherapy, and we provide a review of the literature on the topic.

Nelarabine-associated myelopathy in a patient with acute lymphoblastic leukaemia: Case report

“…No treatment was given or specified in five of the cases reviewed. 11,14 Among the nine patients who did receive therapy, five received corticosteroids, 7–9,15,16 five received intravenous immunoglobulins 8–10 (leading to clinical worsening following its administration in one of the cases 9 ), four underwent intensive rehabilitation, 7,9,12,16 two received vitamin supplements including vitamin B12, 9,15 and two were treated with therapeutic plasma exchange. 9,15 Our patient received corticosteroid therapy, intensive rehabilitation, therapeutic plasma exchange, and vitamin supplements with vitamins B12 and B6 for the treatment of neurotoxicity.…”

“…No treatment was given or specified in five of the cases reviewed. 11,14 Among the nine patients who did receive therapy, five received corticosteroids, [7][8][9]15,16 Asparaginase IV Figure 1. Chemotherapy regimens administered.…”

“…This led to a slight improvement of paraplegia which may have been more severe as a result of the meningitis that occurred during the Allo-HSCT. With regard to the degree of response in the other cases, a single case of reversible neuropathy, 16 one case of progression to irreversible paraplegia, 7 and three cases of improvement of neurological impairment 8,9,12 have been described. In the remaining nine cases, the neurological status was not specified.…”

Salvage Therapy in Early Relapse of T-Lymphoblastic Leukemia/Lymphoma Using Daratumumab/Nelarabine Combination: Two Consecutive Cases

“…The neurological impairment was characterized by neurologists after MR scan showing medullopathy, as well as clinical and neurophysiological examinations. It was presumably caused by a combination of nelarabine and radiotherapy as reported earlier [ 10 , 11 ]. A possible complicating role of daratumumab cannot be excluded but is not considered likely, given the well-known neurotoxic potential of nelarabine.…”