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The Role of Nelarabine in the Treatment of T-cell Acute Lymphoblastic Leukemia: Literature Review and Own Experience

The Role of Nelarabine in the Treatment of T-cell Acute Lymphoblastic Leukemia: Literature Review and Own Experience

Y Y Dyakonova, O I Bydanov, A M Popov, Y V Olshanskaya, E G Boichenko, O V Aleynikova, M A Maschan, L N Shelikhova, D V Litvinov, L A Khachatryan, N I Ponomareva, L G Fechina, G A Novichkova, E D Pashanov, etc.

Ter Arkh. 2018 Aug 17;90(7):38-50.

PMID: 30701921

Abstract:

Aim:
The analysis of experience of nelarabine use in refractory/relapsed T-cell acute lymphoblastic leukemia (T-ALL) depending on the immunophenotype and the line of therapy.
Materials and methods:
All the patients with relapsed or refractory T-ALL aged from 0 to 18 years who received treatment with nelarabine as a part of the therapeutic element R6 were included in the study. For all patients a detailed immunological analysis of leukemia cells with discrimination of immunological variants TI, TII, TIII or TIV was performed. Patients administered with nelarabine as a first therapeutic element were referred to the first-line therapy group, other patients were referred to the second-line therapy group. Nelarabine was ad- ministered as intravenous infusion at a dose of 650 mg/m2, on days 1-5. Allogeneic hematopoietic stem cells transplantation (allo-HSCT) was considered for all patients.
Results:
From 2009 to 2017, 54 patients with refractory/relapsed T-ALL were treated with nelarabine. Five-year event-free survival (EFS) and overall survival (OS) was 28% for all patients, cumulative risk of relapse (CIR) was 27%. EFS was significantly higher in nelarabine first-line therapy group in comparison with second-line therapy group (34±8% vs 8±8%, p=0,05). In patients after allo-HSCT EFS, OS and CIR were 51±10%, 50±10% and 39,1±9,5% accordingly. The best results were achieved in patients with TI immunophenotype. No toxicity-related mortality as well as severe neurologic complications or discontinuation of therapy associated with use of nelarabine were reported.
Conclusion:
The use of nelarabine is an effective strategy for the treatment of relapsed and refractory T-ALL. The best treatment outcomes were obtained in patients with TI immunophenotype and in the first-line therapy group. Optimal dosage regimens can be established dur- ing controlled clinical trials.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP121032299	Nelarabine		121032-29-9	Price

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