ArticleClinical lymphoma, myeloma & leukemia2024
Incidence and Clinical Presentation of Severe Neurotoxicity from Nelarabine in Patients with T-Cell Acute Lymphoblastic Leukemia.
Article in Clinical lymphoma, myeloma & leukemia, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Disproportionality Analysis and Timing of Drug-Associated Guillain-Barré Syndrome Onset Based on the Japanese Adverse Drug Event Report Database.Pharmaceuticals (Basel, Switzerland) · 2026Article
- Mechanistic Insights into Drug-Induced Guillain-Barré Syndrome: A Large-Cohort Analysis of the FAERS Database.Pharmaceuticals (Basel, Switzerland) · 2025Article
- NELARABINE-ASSOCIATED CENTRAL NERVOUS NEUROTOXICITY INDUCING GUILLAIN-BARRE-LIKE/MYELOPATHY: INPATIENT REHABILITATION AND FUNCTIONAL OUTCOMES.Journal of rehabilitation medicine. Clinical communications · 2025Article
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9 authors.
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Abstract
backgroundNelarabine is a purine analog with demonstrated efficacy in the treatment of T-cell Lymphoblastic Leukemia and Lymphoma (T-ALL/LBL). Despite its efficacy and excellent blood-brain barrier penetration, it has a significant side effect profile which is namely concerning for neurotoxicity. Reported neurotoxicity has varied from mild peripheral neuropathy to debilitating grade 4 neurologic complications including Guillain-Barre like syndrome and myelopathy. PATIENTS AND
methodsWe conducted a single centered, retrospective case series to study patients who developed severe neurotoxicity after receiving nelarabine as part of T-ALL treatment. One hundred thirty-five patients were identified. Thirteen patients were reviewed for severe neurotoxicity (defined as ≥grade 3), and of those five patients were deemed to have neurotoxicity secondary to nelarabine exposure.
resultsFive patients (4%) developed severe neurotoxicity as manifested by Guillain-Barre like syndrome or myelopathy within a timeframe of eight to fifty-eight days from last nelarabine dose. Upon diagnosis, patients received formal neurologic evaluation by our neuro-oncology specialists including imaging, cerebrospinal fluid testing, and electromyography. Patients were treated with IVIG, and steroids upon diagnosis, but the majority of neuro-deficits were irreversible.
conclusionOur study shows that nelarabine is generally well-tolerated, and the incidence of severe neurotoxicity is rare. Given the potential risk of severe neurotoxicity, we propose capped dose of nelarabine 1000 mg/day, neurological assessment before subsequent dosing, and avoidance of simultaneous IT therapy during nelarabine administration.
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