title: Clofarabine-based combination chemotherapy for relapse and refractory childhood acute lymphoblastic leukemia.
abstract: Clofarabine, one of the key treatment agents for refractory and relapsed acute lymphoblastic leukemia (ALL), achieves a remission rate of approximately 30% with single-agent clofarabine induction chemotherapy. However, a remission rate of approximately 50% was reported with a combination chemotherapy regimen consisting of clofarabine, etoposide, and cyclophosphamide. We treated two cases with refractory and relapsed ALL with combination chemotherapy including clofarabine; one was an induction failure but the other achieved remission. Both cases developed an infectious complication (NCI-CTCAE grade 3) and body pain with infusion. Prophylactic antibiotic and opioid infusions facilitated avoiding septic shock and pain. Further investigation of such cases is required.
authors.affiliation: Department of Hematology/Oncology, Saitama Children's Medical Center.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Arakawa
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Koh
authors.forename: Takahiro
authors.initials: T
authors.lastname: Aoki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kubota
authors.forename: Ryo
authors.initials: R
authors.lastname: Oyama
authors.forename: Makiko
authors.initials: M
authors.lastname: Mori
authors.forename: Mayumi
authors.initials: M
authors.lastname: Hayashi
authors.forename: Ryoji
authors.initials: R
authors.lastname: Hanada
mesh_terms: D000227:Adenine Nucleotides / Q000008:administration & dosage*; D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001087:Arabinonucleosides / Q000008:administration & dosage*; D002437:Cefazolin / Q000008:administration & dosage; D002648:Child; D000077866:Clofarabine; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D010146:Pain / Q000517:prevention & control; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012008:Recurrence; D012074:Remission Induction; D012772:Shock, Septic / Q000517:prevention & control; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000227:Adenine Nucleotides; D000701:Analgesics, Opioid; D001087:Arabinonucleosides; D005047:Etoposide; D000077866:Clofarabine; D003520:Cyclophosphamide; D002437:Cefazolin; D005283:Fentanyl