Nelarabine in T-Cell Acute Lymphoblastic Leukemia: An Analysis of the Literature
Hani Raka Karrar *
Pharmaceutical Care, Faculty of Pharmacy, Dr. Samir Abbas Hospital, Jeddah, Alazhar University, Jeddah, SAU, Saudi Arabia.
Mahmoud Ismail Nouh
Pharmaceutical Care, Medicine Department, King Fahad Armed Forces Hospital, Ibn Sina, National College for Medical Studies, Jeddah, SAU, Saudi Arabia.
Maria Talal Kufyah
Maternity and Children Hospital, Makkah, SAU, Saudi Arabia.
Amal Mueidh Alshehri
Princess Nourah Bint Abdul Rahman University, Riyadh, SAU, Saudi Arabia.
Rahaf Mohammed Zuhair
King Abdulaziz Hospital, Ministry of Health, SAU, Saudi Arabia.
Ahad Hamdi Alanazi
Security Forces Hospital, Riyadh, SAU, Saudi Arabia.
Faisal Abdulrahman Alahmari
King Fahad Medical City, SAU, Saudi Arabia.
Mohammed Yahya Bakhan Alqarni
Wadi Aldawaser General Hospital, SAU, Saudi Arabia.
Saleh Jabbar Saleh Alzahrani
Directorate of Health Affairs in Taif, SAU, Saudi Arabia.
Amera Gassem Ghzwani
Pharmabrand Pharmacy Company, Gazan, SAU, Saudi Arabia.
Abdulrahman Olayan Almuqati
Shaqra General Hospital, SAU, Saudi Arabia.
Muhannad Ibrahim Aldhuwayhi
General Directorate of Prison Health, SAU, Saudi Arabia.
Turki Othman Ali Alharbi
King Abdulaziz Hospital, Saudi Arabia.
Khloud Mubark Alotaibi
Security Forces Hospital, Makkah, SAU, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
T-cell acute lymphoblastic leukemia (T-ALL) represents a highly aggressive hematological malignancy predominantly affecting adolescents and young adults. Despite advancements in treatment modalities, including multi-agent chemotherapy, the prognosis remains unfavorable, particularly for individuals with relapsed or refractory disease. The intricate nature of T-ALL, marked by genetic heterogeneity and early dissemination, necessitates the investigation of novel therapeutic agents to improve treatment efficacy and enhance survival rates. Standard intervention primarily encompasses chemotherapy and, in some instances, stem cell transplantation; however, the occurrence of early relapse emphasizes the critical need for alternative therapies that target the fundamental biology of T-ALL.Recent advancements in understanding the molecular and genetic underpinnings of T-ALL have facilitated the formulation of personalized therapeutic approaches and immunotherapeutic strategies. Nelarabine, a pro-drug of arabinosyl guanine (ara-G), has emerged as a promising candidate for relapsed or refractory scenarios. This agent specifically targets T-cells, integrating into their DNA to obstruct synthesis and repair processes, thereby effectively eradicating rapidly proliferating cancer cells. Laboratory investigations highlight nelarabine's robust anti-leukemic properties, while early clinical trials reveal substantial recovery rates, especially among pediatric patients. Notably, a pivotal study conducted by the Children’s Oncology Group demonstrated considerable efficacy in the treatment of relapsed T-ALL, particularly when administered in conjunction with corticosteroids and vincristine, indicating improved treatment outcomes
Keywords: Nelarabine, T-Cell acute lymphoblastic, lymphoblastic leukemia