[Severe liver injury following nelarabine chemotherapy for T-cell lymphoblastic lymphoma].

A 41-year-old man received allogeneic hematopoietic stem cell transplantation for T-cell lymphoblastic lymphoma. Recurrence occurred 20 months post-transplantation. Combination chemotherapy (etoposide, prednisolone, daunorubicin, vincristine) was performed, but the effect was limited, necessitating nelarabine administration. After 2 courses (1.5 g/m2/day, days 1, 3, 5), blood chemistry indicated severe liver injury. DDW-J 2004 guidelines on drug-induced liver injury indicated nelarabine as the most plausible etiologic agent. After administering ursodeoxycholic acid, phenobarbital and prednisolone, liver function improved. Although previous studies reported neurotoxicity as the most frequent and severe toxicity, we also need to consider that severe liver injury might be induced by nelarabine.