Clofarabine-based chemotherapy as a bridge to transplant in the setting of refractory or relapsed acute myeloid leukemia, after at least one previous unsuccessful salvage treatment containing fludarabine: a single institution experience.
For refractory or relapsed acute myeloid leukemia patients, allogeneic hematopoietic stem cell transplantation is the only curative treatment option, but the disease must be in remission before this can be attempted. "Salvage" therapy regimens containing high-dose cytarabine plus fludarabine or cladribine with or without anthracyclines or plus mitoxantrone and etoposide fail in 30-50% of cases. We report the outcome of 14 patients treated with a clofarabine-based treatment administered after at least one failed fludarabine-based "salvage" attempt in a "real life" (outside a clinical trial) context. No death related to the clofarabine-based treatment was observed. Four of the 14 patients (29%) reached complete remission and one (7%) achieved a reduction of marrow blasts to fewer than 10%. Three of these five patients were successfully transplanted and have shown a long-term survival. The small number of this group of patients does not permit the identification of clinical features clearly related to a favorable outcome, but we note that all the three long-term survivals were FLT3 wild type. Clofarabine-based "salvage therapy" in patients with very poor expectancy is feasible even after a fludarabine-based salvage attempt, albeit with success only in a small percentage of cases (3/14 = 21%).
['Molteni|Alfredo|A|http://orcid.org/0000-0001-5380-1483', 'Riva|Marta|M|', 'Ravano|Emanuele|E|', 'Marbello|Laura|L|', 'Mancini|Valentina|V|', 'Grillo|Giovanni|G|', 'Zucchetti|Elisa|E|', 'Greco|Rosa|R|', 'Cairoli|Roberto|R|']
D000227:Adenine Nucleotides D000293:Adolescent D000328:Adult D000368:Aged D064591:Allografts D001087:Arabinonucleosides D000077866:Clofarabine D018572:Disease-Free Survival D005260:Female D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D015470:Leukemia, Myeloid, Acute D008297:Male D008875:Middle Aged D012008:Recurrence D012189:Retrospective Studies D016879:Salvage Therapy D014740:Vidarabine
Salvage therapy Clofarabine Relapsed/refractory AML