title: A clofarabine-based bridging regimen in patients with relapsed ALL and persistent minimal residual disease (MRD).
abstract: In patients with relapsed ALL, minimal residual disease (MRD) identified prior to allogeneic hematopoietic cell transplantation (HCT) is a strong predictor of relapse. We report our experience using a combination of reduced-dosing clofarabine, CY and etoposide as a 'bridge' to HCT in eight patients with high risk or relapsed ALL and pre-HCT MRD. All patients had detectable MRD (>0.01%, flow cytometry) at the start of therapy with all eight achieving MRD reduction following one cycle. The regimen was well tolerated with seven grade 3/4 toxicities occurring among four of the eight patients. Five patients (62.5%) are alive, one died from relapse (12.5%) and two from transplant-related mortality (25%). The combination of reduced-dose clofarabine, CY and etoposide as bridging therapy appears to be well tolerated in patients with relapsed ALL and is effective in reducing pre-HCT MRD.
authors: Department of Pediatrics, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN, USA.
authors: N
authors: N
authors: Gossai
authors: Division of Pediatric Blood and Marrow Transplantation, University of Minnesota Amplatz Children's Hospital, Minneapolis, MN, USA.
authors: M R
authors: MR
authors: Verneris
authors: Division of Pediatric Hematopoietic Stem Cell Transplantation, City of Hope, Duarte, CA, USA.
authors: N A
authors: NA
authors: Karras
authors: Division of Pediatric Hematology-Oncology, Kaiser Permanente-Oakland, Santa Clara, CA, USA.
authors: M F
authors: MF
authors: Gorman
authors: Division of Pediatric Hematology-Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors: N J
authors: NJ
authors: Patel
authors: Division of Pediatric Hematology-Oncology-BMT, Medical College of Wisconsin, Milwaukee, WI, USA.
authors: M J
authors: MJ
authors: Burke
mesh_terms: D000227:Adenine Nucleotides / Q000008:administration & dosage*; D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D001087:Arabinonucleosides / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D000077866:Clofarabine; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011336:Probability; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000227:Adenine Nucleotides; D000964:Antimetabolites, Antineoplastic; D001087:Arabinonucleosides; D005047:Etoposide; D000077866:Clofarabine; D003520:Cyclophosphamide