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Case Reports
. 2023 Jun;117(6):933-940.
doi: 10.1007/s12185-023-03539-5. Epub 2023 Jan 27.

Nelarabine-induced myelopathy in patients undergoing allogeneic hematopoietic cell transplantation: a report of three cases

Takanori Fukuta  1 , Takashi Tanaka  2 , Taiki Hashimoto  3 , Kenji Isahaya  4 , Yuko Kubo  5 , Yoshihisa Yamano  4 , Kaishi Satomi  3 , Nobuyoshi Hiraoka  3 , Nami Shirakawa  6 , Ayumu Arakawa  6 , Chitose Ogawa  6 , Nao Nishimura  1 , Jun Aoki  1 , Ayumu Ito  1 , Yoshihiro Inamoto  1 , Sung-Won Kim  1 , Takahiro Fukuda  1
Affiliations
Case Reports

Nelarabine-induced myelopathy in patients undergoing allogeneic hematopoietic cell transplantation: a report of three cases

Takanori Fukuta et al. Int J Hematol. 2023 Jun.

Abstract

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.

Keywords: Allogeneic hematopoietic cell transplantation; Autopsy; Myelopathy; Nelarabine; T-cell acute lymphoblastic leukemia/lymphoma.

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