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\begin{document}

\title{Central Nervous System Neurotoxicity Associated with Nelarabine in
T-cell Acute Lymphoblastic Leukemia}



\author[1]{Umur Pehlivan}%
\author[2]{Emel Gurkan}%
\author[2]{Ibrahim Acar}%
\author[2]{Yunus Bicakci}%
\affil[1]{Van Baskale State Hospital}%
\affil[2]{Cukurova University Faculty of Medicine}%


\vspace{-1em}



  
  \date{May 25, 2024}


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\begin{abstract}
Nelarabine, a prodrug of arabinosylguanine has lineage-specific toxicity
for T lymphoblasts and is used to treat refractory or relapsed T-cell
acute lymphoblastic leukaemia (T-ALL) and T-cell lymphoblastic lymphoma
patients. The most commonly observed adverse effects associated with
nelarabine are mainly haematological i.e., neutropenia, anaemia, and
thrombocytopenia. Additionally, neurological, and gastrointestinal
toxicities have been reported. Neurotoxicity associated with nelarabine
is rare. Here, we presented a young adult patient diagnosed with T-ALL
who experienced a nucleus caudatus infarction, and toxic
leukoencephalopathy (TL) during treatment with nelarabine. Computed
tomography and magnetic resonance imaging have shown periventricular and
nucleus caudatus abnormalities. Radiological findings suggested TL and
acute infarct of right nucleus caudatus. After high-dose steroids,
intravenous immunoglobulin, and support treatment, his neurologic
symptoms disappeared except for mild peroral numbness. However,
radiological sequelae persisted despite clinical improvement. Physicians
involved in the care of these patients who use nelarabine should be
aware of the fact that cerebral toxicity of the nelarabine may occur
especially in the presence of predisposing factors. It is crucial to
monitor closely those patients receiving nelarabine and also those who
have additional predisposing factors for neurotoxicity.%
\end{abstract}%



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