| Autor: |
Takanori Fukuta, Takashi Tanaka, Taiki Hashimoto, Kenji Isahaya, Yuko Kubo, Yoshihisa Yamano, Kaishi Satomi, Nobuyoshi Hiraoka, Nami Shirakawa, Ayumu Arakawa, Chitose Ogawa, Nao Nishimura, Jun Aoki, Ayumu Ito, Yoshihiro Inamoto, Sung-Won Kim, Takahiro Fukuda |
| Rok vydání: |
2022 |
| DOI: |
10.21203/rs.3.rs-1643949/v1 |
| Popis: |
Background: Nelarabine is an effective treatment for T-cell acute lymphoblastic leukemia/lymphoma. Myelopathy is a problematic adverse event associated with nelarabine. The mechanism leading to myelopathy is unclear. Diagnostic methods and therapy for nelarabine-induced myelopathy have not been established.Case presentation: Three patients who received allogeneic hematopoietic cell transplantation (allo-HCT) after nelarabine administration at the National Cancer Center Hospital from December 2014 to March 2021 developed myelopathy. They developed myelopathy 20 days before allo-HCT, 12 days after allo-HCT, and 29 days after allo-HCT, respectively. The intervals from last nelarabine administration to onset of myelopathy were 41 days, 121 days, and 47 days, respectively. The initial symptom was paresthesia in the lower legs in all patients. In two of three patients, magnetic resonance imaging showed lesions in the dorsal column or medulla oblongata, a characteristic finding of nelarabine-induced myelopathy that was similar to findings in mitochondrial diseases. We treated all three patients with intravenous immunoglobulin and methylprednisolone, but all became unable to walk. One patient died on day 101 due to the progression of neurotoxicity. In the other two patients, neurological symptoms spontaneously improved. One patient is alive and became able to walk with a cane despite some muscle weakness in his lower extremities by 8 months after allo-HCT. The other patient was able to move around in a wheelchair but died of mucormycosis on day 476 after allo-HCT. Postmortem autopsy of two patients showed spongiosis of the posterior funiculus. One patient also had the same finding in the medulla oblongata.Conclusions: Nelarabine is a valid treatment option. However, these cases suggest that allo-HCT can worsen nelarabine-induced myelopathy, a potentially fatal condition for which there is no effective treatment. Elucidation of the mechanism and establishment of diagnostic methods and therapies for nelarabine-induced myelopathy are needed. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
|
