The role of nelarabine in the treatment of T-cell acute lymphoblastic leukemia: literature review and own experience
Аннотация: 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 administered 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 during controlled clinical trials.
Год издания: 2018
Авторы: Yu. Yu. Dyakonova, О. И. Быданов, А. М. Попов, Yulia Olshanskaya, Э Г Бойченко, Olga Aleynikova, Michael Maschan, Larisa Shelikhova, Д. В. Литвинов, L. A. Khachatryan, Natalia Ponomareva, Л. Г. Фечина, Galina Novichkova, ED Pashanov, Alexander Karachunskiy
Издательство: Consilium Medicum
Источник: Terapevticheskii arkhiv
Ключевые слова: Acute Lymphoblastic Leukemia research, Cancer therapeutics and mechanisms, Childhood Cancer Survivors' Quality of Life
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Том: 90
Выпуск: 7
Страницы: 37–50