4  T-ALL

4.1 COG AALL0434

• Phase 3 trial for newly diagnosed high-risk B-ALL and T-ALL patients aged 1-30 years

4.2 Nelarabine

• A prodrug of the deoxyguanosine analog ara-G, nelarabine is a rationally designed agent selective for the treatment of T-cell malignancies.
• CALGB 19801 (DeAngelo et al. 2007): Nelarabine (Arranon) 1500 mg/m2 IV over 2 hours once per day on days 1, 3, 5
• 21-day cycle for 3 to 4 cycles (or delayed for count recovery)

4.2.1 Review of Nelarabine in T-ALL

• An excellent article reviewing nelarabine in T-ALL is available here (Hormann and Rudd 2025)

DeAngelo, Daniel J., Daohai Yu, Jeffrey L. Johnson, et al. 2007. “Nelarabine Induces Complete Remissions in Adults with Relapsed or Refractory t-Lineage Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma: Cancer and Leukemia Group b Study 19801.” Blood 109 (12): 5136–42. https://doi.org/10.1182/blood-2006-11-056754.

Hormann, Femke M., and Sean G. Rudd. 2025. “Nelarabine in t-Cell Acute Lymphoblastic Leukemia: Intracellular Metabolism and Molecular Mode-of-Action.” Leukemia 39 (3): 531–42. https://doi.org/10.1038/s41375-025-02529-2.