Haider Mahnur, Rizvi Syed Ahsan, Kasi Pashtoon Murtaza
Division of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
Case Rep Hematol. 2015;2015:825670. doi: 10.1155/2015/825670. Epub 2015 Mar 18.
Nelarabine (ara-G; Arranon; compound 506U78) is an antineoplastic purine analog used for the treatment of refractory or relapsed T-cell acute lymphoblastic leukemia (T-ALL) and T-cell lymphoblastic lymphoma (T-LBL). The drug was granted accelerated approval in October 2005 by the US Food and Drug Administration (FDA) given the efficacy (induction of complete responses) noted in 2 single-arm trials (one in pediatric setting and one in adult patient population). The main spectra of toxicities that have been reported in these clinical trials and subsequent studies are hematological and neurological. Nelarabine induced rhabdomyolysis and increased creatinine phosphokinase (CK; CPK) levels apparently have been reported and this side effect has been added as an adverse reaction in the product monograph from the drug company during postmarketing surveillance. However, the true extent and incidence of the myotoxicity from the drug are unclear. In this paper we report a grade IV CK elevation and rhabdomyolysis in a patient with T-ALL treated with nelarabine. Given the reported finding, we examined the literature further for myotoxicity, increased CK, and/or rhabdomyolysis associated with the use of the nelarabine and report our findings.
奈拉滨（ara - G；Arranon；化合物506U78）是一种抗肿瘤嘌呤类似物，用于治疗难治性或复发性T细胞急性淋巴细胞白血病（T - ALL）和T细胞淋巴母细胞淋巴瘤（T - LBL）。鉴于两项单臂试验（一项在儿科患者中进行，一项在成年患者群体中进行）中观察到的疗效（诱导完全缓解），该药物于2005年10月获得美国食品药品监督管理局（FDA）的加速批准。这些临床试验及后续研究中报告的主要毒性谱为血液学和神经学方面的。奈拉滨诱导的横纹肌溶解和肌酐磷酸激酶（CK；CPK）水平升高显然已有报告，并且在上市后监测期间，这种副作用已作为不良反应添加到药品说明书中。然而，该药物导致的肌毒性的真实程度和发生率尚不清楚。在本文中，我们报告了1例接受奈拉滨治疗的T - ALL患者出现IV级CK升高和横纹肌溶解的情况。鉴于已报告的这一发现，我们进一步查阅了与使用奈拉滨相关的肌毒性、CK升高和/或横纹肌溶解的文献，并报告我们的研究结果。
