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The combination of hyper-CVAD plus nelarabine as frontline therapy in adult T-cell acute lymphoblastic leukemia and T-lymphoblastic lymphoma: MD Anderson Cancer Center experience

Leukemia volume 28, pages 973–975 (2014)Cite this article

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Therapeutic options in adult T-cell acute lymphoblastic leukemia and T-lymphoblastic lymphoma (T-ALL/LL) are limited.1 We have earlier demonstrated that the hyper-CVAD regimen achieves high rates of complete remission (CR) and improves clinical outcomes in patients with T-ALL/LL.2 However, ∼50% of patients relapse and further improvements of the therapeutic armamentarium are needed.

Nelarabine is a prodrug of 9-β-arabinofuranosylguanine (ara-G).3, 4 Preferential accumulation of ara-G inside the T lymphoblasts prevents DNA replication and causes apoptosis and makes it an ideal purine nucleoside analogue with T-cell specificity.5, 6 Clinical studies of nelarabine in pediatric and adult patients with relapsed/refractory T-ALL/LL have confirmed a substantial level of activity,7, 8, 9, 10 and in 2005 the Food and Drug Administration (FDA) granted accelerated approval for nelarabine in this patient population.11 One trial has shown that nelarabine could be safely combined with intensive chemotherapy (BFM-86) in the frontline therapy of pediatric T-ALL.12 We therefore studied the efficacy and safety of nelarabine in combination with hyper-CVAD in the frontline therapy for adult patients with T-ALL/LL.

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Acknowledgements

This study was supported partly by GlaxoSmithKline Pharmaceuticals (to SF).

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Authors and Affiliations

  1. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    P Jain, H Kantarjian, F Ravandi, D Thomas, S O'Brien, T Kadia, J Burger, G Borthakur, N Daver, E Jabbour, M Konopleva, J Cortes, N Pemmaraju, M A Kelly, M Cardenas-Turanzas, R Garris & S Faderl

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  1. P Jain
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Corresponding author

Correspondence to S Faderl.

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The authors declare no conflict of interest.

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Author Contributions

PJ, HK and SF designed the study. PJ, RG, MC-T, DT, SOB and SF analyzed the results. PJ, HK, RG, MC-T, DT, SOB and SF wrote the paper. HK, DT, ND, NP, FR, MK, JB, SOB, EJ, JC, GB, TK and SF contributed the patient samples. All authors reviewed and gave the final approval for the paper.

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Jain, P., Kantarjian, H., Ravandi, F. et al. The combination of hyper-CVAD plus nelarabine as frontline therapy in adult T-cell acute lymphoblastic leukemia and T-lymphoblastic lymphoma: MD Anderson Cancer Center experience. Leukemia 28, 973–975 (2014). https://doi.org/10.1038/leu.2013.312

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