Standardized Neurologic Assessment Documentation for Daily Nelarabine Administration: A Bedside Questionnaire

Nelarabine is an essential component in the treatment of pediatric T-cell lymphoblastic malignancies. Rare high-grade neurologic toxicities have been reported, but nelarabine discontinuation when early symptoms arise mitigates poor outcomes. Currently, no standard assessment of neurotoxicity exists. Our patient safety initiative implemented a novel 7-question neurologic assessment tool performed daily during nelarabine courses, which prompted early identification of neurotoxicity and allowed for appropriate interventions. Investigating 31 patients over 18 months demonstrated improved documentation from 65.9% to 97.2% (Δ+31.3%). Nine doses were omitted due to discovered neurotoxicity. Tool implementation advanced our ability to optimize patient care during nelarabine administration.