Nelarabine-induced peripheral and central neurotoxicity: can sequential MRI brain imaging help to define its natural history?
A 14-year-old boy with relapsed T cell acute lymphoblastic leukaemia received reinduction chemotherapy that included nelarabine, a purine nucleoside analogue known to cause dose-dependent neurotoxicity. Although he achieved aminimal residual disease negative remission after two cycles of chemotherapy he also developed severe, progressive peripheral and central neurotoxicities. Loss of grey-white differentiation was seen on a T2-weighted magnetic resonance imaging brain scan. This unusual clinical picture and previously unreported radiological findings are thought to be due to nelarabine toxicity. He was bridged with 6-mercaptopurine while transplant was deferred pending sustainable neurological improvement. This case posed clinical and ethical dilemmas while demonstrating previously unreported radiological features.
['Ewins|Karl|K|', 'Malone|Andrea|A|', 'Phelan|Ethna|E|', 'Webb|David|D|', 'McHugh|J C|JC|', 'Smith|Owen|O|']
D000293:Adolescent D001087:Arabinonucleosides D001921:Brain D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D020258:Neurotoxicity Syndromes D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
neurotoxicity MRI brain nelarabine allogeneic transplant relapsed T-ALL