Imaging Findings in Children Presenting with CNS Nelarabine Toxicity.
Bettina L SerrallachEric S SchaferStephen F KralikH D B TranThierry A G M HuismanJason N WrightLindsey A MorganNilesh K DesaiPublished in: AJNR. American journal of neuroradiology (2022)
Nelarabine is a nucleoside analog critical for the treatment of patients with T-cell acute lymphoblastic leukemia/lymphoma. However, clinical peripheral and central neurologic adverse events associated with nelarabine administration have been reported. Neuroimaging of brain neurotoxicity has only been described in very few reports in pediatric patients so far. Six children with diagnosed T-cell acute lymphoblastic leukemia who clinically experienced possible, probable, or definite nelarabine-induced toxicity and underwent spine and/or brain MR imaging were reviewed. Neuroimaging findings showed a mixture of patterns including features of acute toxic leukoencephalopathy (seen in 6 cases), posterior reversible encephalopathy syndrome (2 cases), involvement of deep gray structures (1 case) and brainstem (2 cases), cranial and spinal neuropathy (2 cases each), and myelopathy (2 cases). Even though neuroimaging findings are nonspecific, the goal of this article was to alert the pediatric neuroradiologists, radiologists, and clinicians about the possibility of nelarabine-induced neurotoxicity and its broad neuroimaging spectrum.
Keyphrases
- acute lymphoblastic leukemia
- high resolution
- spinal cord
- young adults
- drug induced
- oxidative stress
- high glucose
- case report
- resting state
- allogeneic hematopoietic stem cell transplantation
- liver failure
- emergency department
- mass spectrometry
- computed tomography
- palliative care
- early onset
- machine learning
- blood brain barrier
- cerebral ischemia
- diffuse large b cell lymphoma
- endothelial cells
- spinal cord injury
- brain injury
- magnetic resonance
- fluorescence imaging
- functional connectivity
- acute respiratory distress syndrome
- electronic health record
- aortic dissection