Nelarabine-associated central nervous neurotoxicity inducing Guillain-Barre-like/myelopathy: inpatient rehabilitation and functional outcomes

Objective: Nelarabine is an antineoplastic agent used in the treatment of acute T-cell lymphoblastic lymphoma with inadequate clinical response to prior chemotherapeutic treatments. While the most common side effects are mild to moderate haematologic events, there are known severe neurologic side effects including induced myelopathy. Due to the sparsity of cases, there is a lack of literature to guide inpatient rehabilitation programs for patients with neurological toxicity. Design: Case report. Patient: A 30-year-old woman with a history of T-cell lymphoblastic lymphoma presenting with tetraplegia after treatment with nelarabine and treated with intravenous immunoglobulin and plasma exchange therapy. Methods: After medically stabilized, she was admitted to acute inpatient rehabilitation centre with therapy program incorporating strengthening and endurance training, robot-assisted training and respiratory muscle strength training. Results: The patient demonstrated marked improvement in functional independence and manual motor testing on discharge. With ongoing participation in out-patient therapies, she achieved full independence with bed mobility and activities of daily living at a 6-month follow-up. She continues to use a wheelchair in the community, demonstrates modified independence with ambulation and is capable of climbing stairs at home. Conclusion: This case report details the functional improvements following intensive rehabilitation of a patient with severe nelarabine-associated neurotoxicity.