Successful stem cell transplantation after nelarabine, pegylated asparaginase, vincristine, doxorubicin, and prednisone in refractory early T- cell precursor acute lymphoblastic leukemia: A case report

Early T -cell precursor Acute Lymphoblastic Leukemia (ALL) has a dismal prognosis. Nelarabine is a purine nucleoside analog that increases the apoptosis rate in T -cell lympho-blasts. We present a 30-year -old patient diagnosed with T -cell ALL. He was a high -risk pa-tient because of an early precursor phenotype and a complex karyotype that had been refractory to three previous lines of treatment. He started a course of nelarabine (1500 mg/ m2 for three days), pegylated-asparaginase, doxorubicin, vincristine, and prednisone (Nelarabine Peg -Asp AdmVP). He reached complete remission and received an allogeneic sibling hematopoietic stem cell transplant with fludarabine, total body irradiation, and cyclo-phosphamide as the conditioning regimen. He developed a pulmonary mycosis, which re-solved, and grade -2 neurotoxicity in his upper and lower limbs. He was discharged after 40 days and to date remains with 23 months of complete remission. The Nelarabine Peg -Asp AdmVP regimen seems to be effective and safe. Further research is needed to establish it as an induction treatment in refractory early T -cell precursor acute lymphoblastic leucemia.