title: Cytoreductive treatment with clofarabine/ara-C combined with reduced-intensity conditioning and allogeneic stem cell transplantation in patients with high-risk, relapsed, or refractory acute myeloid leukemia and advanced myelodysplastic syndrome.
abstract: The combination of cytoreductive chemotherapy with reduced-intensity conditioning (RIC) is a highly effective antileukemic therapy. Purpose of this retrospective analysis was to evaluate the antileukemic efficacy and toxicity of clofarabine-based chemotherapy followed by RIC and allogeneic stem cell transplantation (SCT) for high-risk, relapsed, or refractory acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). From May 2007 until October 2009, a total of 27 patients underwent allogeneic SCT after treatment with clofarabine and ara-C for 5d and RIC (4Gy TBI/cyclophosphamide/ATG). Prophylaxis of graft-versus-host disease (GvHD) consisted of cyclosporine and mycophenolate mofetil. Unmanipulated G-CSF mobilized PBSC (n=26) or bone marrow cells (n=1) were transplanted from unrelated (n=21) or matched related (n=6) donors. Non-hematological toxicities of this regimen mainly affected liver and skin and were all reversible. Seven patients relapsed within a median time of 5.7 months. The overall survival (OS) and relapse-free survival rates were 56% and 52% at 2 yr, respectively. In this cohort of patients, cytoreduction with clofarabine/ara-C (ClAraC) followed by RIC allogeneic SCT was well tolerated and showed good antileukemic efficacy even in patients with high-risk AML or MDS, with engraftment and GvHD-incidence comparable to other RIC regimens.
authors: Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany. buchholz.stefanie@mh-hannover.de
authors: Stefanie
authors: S
authors: Buchholz
authors: Elke
authors: E
authors: Dammann
authors: Michael
authors: M
authors: Stadler
authors: Juergen
authors: J
authors: Krauter
authors: Gernot
authors: G
authors: Beutel
authors: Arne
authors: A
authors: Trummer
authors: Matthias
authors: M
authors: Eder
authors: Arnold
authors: A
authors: Ganser
mesh_terms: D000227:Adenine Nucleotides / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001087:Arabinonucleosides / Q000008:administration & dosage; D000077866:Clofarabine; D016572:Cyclosporine / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D000227:Adenine Nucleotides; D001087:Arabinonucleosides; D007166:Immunosuppressive Agents; D003561:Cytarabine; D000077866:Clofarabine; D016572:Cyclosporine; D009173:Mycophenolic Acid