{"entity":{"id":"paper-aall0434-nelarabine-t-all-dunsmore-jco-2020","kind":"paper","name":"AALL0434: nelarabine in newly diagnosed T-cell acute lymphoblastic leukaemia in children and young adults","aka":[],"tldr":"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.\n\nFive-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.","asOf":"2026-09-17","links":[{"label":"J Clin Oncol 2020","url":"https://doi.org/10.1200/JCO.20.00256"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/32813610/"}],"tags":[],"related":[],"cancers":["all-paediatric-high-risk"],"sections":[],"technologies":[],"targets":[],"drugs":["nelarabine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["aall0434"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2020,"doi":"10.1200/JCO.20.00256","pmid":"32813610","authors":"Dunsmore KP, Winter SS, Devidas M, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":1562},"route":"/key-papers/paper-aall0434-nelarabine-t-all-dunsmore-jco-2020/","neighbours":{"cancer":[{"id":"all-paediatric-high-risk","kind":"cancer","name":"High-risk acute lymphoblastic leukaemia in children (high-risk B-ALL and T-ALL)","route":"/cancers/all-paediatric-high-risk/"}],"drug":[{"id":"nelarabine","kind":"drug","name":"Nelarabine","route":"/drugs/nelarabine/"}],"trial":[{"id":"aall0434","kind":"trial","name":"COG AALL0434","route":"/trials/aall0434/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}]}}