NELARABINE TREATMENT IN ADULT PATIENTS WITH REFRACTORY/ RELAPSED T-CELL ACUTE LYMPHOBLASTIC LEUKAEMIA/LYMPHOMA: EXPERIENCE OF A SINGLE CENTRE

Introduction. Modern therapy for relapses and resistant forms of T-cell acute lymphoblastic leukaemia/lymphoma (T-ALL/ LBL) shows poor efficacy. The use of nelarabine can improve the results of therapy in patients with refractory/relapsed T-ALL/LBL.

Aim. To evaluate the efficacy and toxicity of nelarabine treatment combined with etoposide and cyclophosphamide in adult patients with refractory/relapsed T-ALL/LBL.

Materials and methods. During the 2012–2018 period, 10 patients with refractory/relapsed T-ALL aged from 19 to 41 underwent nelarabine treatment. The patients received from 1 to 3 chemotherapy courses including nelarabine 650 mg/m2 (days 1 to 5), etoposide 100 mg/m2 and cyclophosphamide 440 mg/m2 (days 8 to 12). All the patients having achieved complete remission (СR) underwent transplantation of allogeneic haematopoietic stem cells (allo-HSCT). The development of toxic sequelae (myelosuppression, neurotoxicity, incidence of infectious complications) was considered after each chemotherapy course.

Results. Out of 10 patients who received 1–2 chemotherapy courses, 6 (60 %) achieved CR. These 6 patients subsequently underwent allo-HSCT, which was followed by early relapse in 3 (50 %) of 6 patients and the death of 1 patient in persisting CR caused by infectious complications. Only 2 of 6 patients have been monitored for 1.5 years after the allo-HSCT. The five-year overall survival rate in relapsed patients came to 18 %. In terms of toxic sequelae, myelosuppression and infectious complications were observed in all patients. Neurotoxicity was noted in 3 (30 %) out of 10 patients, with two of them experiencing it after each course and one patient — only following the third course of nelarabine treatment.

Conclusion. The use of nelarabine for the treatment of refractory/relapsed T-ALL/LBL provides the opportunity to achieve CR in 60 % of cases, as well as to perform allo-HSCT. However, long-term results are not very optimistic, thus further research is required.

Conflict of interest: the authors declare no conflict of interest.

Financial disclosure: the study had no sponsorship.

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