Nelarabine-induced peripheral and central neurotoxicity: can sequential MRI brain imaging help to define its natural history?

Br J Haematol. 2017 Oct;179(2):294-297. doi: 10.1111/bjh.14921. Epub 2017 Sep 29.


A 14-year-old boy with relapsed T cell acute lymphoblastic leukaemia received reinduction chemotherapy that included nelarabine, a purine nucleoside analogue known to cause dose-dependent neurotoxicity. Although he achieved aminimal residual disease negative remission after two cycles of chemotherapy he also developed severe, progressive peripheral and central neurotoxicities. Loss of grey-white differentiation was seen on a T2-weighted magnetic resonance imaging brain scan. This unusual clinical picture and previously unreported radiological findings are thought to be due to nelarabine toxicity. He was bridged with 6-mercaptopurine while transplant was deferred pending sustainable neurological improvement. This case posed clinical and ethical dilemmas while demonstrating previously unreported radiological features.

Keywords: MRI brain; allogeneic transplant; nelarabine; neurotoxicity; relapsed T-ALL.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Arabinonucleosides / administration & dosage
  • Arabinonucleosides / adverse effects*
  • Brain / diagnostic imaging*
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Neurotoxicity Syndromes / diagnostic imaging*
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / diagnostic imaging
  • Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*


  • Arabinonucleosides
  • nelarabine