# AALL0434: nelarabine in newly diagnosed T-cell acute lymphoblastic leukaemia in children and young adults

Source: https://onco.cc/key-papers/paper-aall0434-nelarabine-t-all-dunsmore-jco-2020/  
OnCo record `paper-aall0434-nelarabine-t-all-dunsmore-jco-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding the T-cell-specific drug nelarabine to intensive chemotherapy improved disease-free survival in childhood T-cell acute lymphoblastic leukaemia and cut central nervous system relapses, in the largest T-ALL trial ever run.

## Summary

Phase 3 trial of 1,895 patients with T-ALL of whom 1,562 were randomised in a factorial design to Capizzi or high-dose methotrexate and, for intermediate- and high-risk patients, to nelarabine or not.

Five-year disease-free survival was 88.2 percent with nelarabine against 82.1 percent without, with fewer central nervous system relapses; Capizzi methotrexate was superior to high-dose methotrexate in this T-cell population, the opposite of B-ALL.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: Journal of Clinical Oncology
- Year: 2020
- DOI: 10.1200/JCO.20.00256
- Authors: Dunsmore KP, Winter SS, Devidas M, et al.
- Findings: Five-year disease-free survival 88.2 percent with nelarabine vs 82.1 percent without.; Overall five-year survival 90.2 percent for the whole T-ALL cohort.
- What it means: Nelarabine is part of standard therapy for intermediate- and high-risk childhood T-ALL, and Capizzi methotrexate is preferred in T-ALL.
- Caveats: Neurotoxicity of nelarabine requires monitoring.; Cranial irradiation was still used for many patients; its omission was tested later.

## Sources

- J Clin Oncol 2020: https://doi.org/10.1200/JCO.20.00256
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32813610/

## Connected records

- cancers: [High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)](https://onco.cc/cancers/all-paediatric-high-risk/)
- drugs: [Nelarabine](https://onco.cc/drugs/nelarabine/)
- trials: [COG AALL0434](https://onco.cc/trials/aall0434/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)

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