title: 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.
abstract: 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%).
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. alfre13667@gmail.com.
authors.forename: Alfredo
authors.identifier: http://orcid.org/0000-0001-5380-1483
authors.initials: A
authors.lastname: Molteni
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Riva
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Ravano
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Marbello
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Mancini
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grillo
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Zucchetti
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Greco
authors.affiliation: Hematology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cairoli
mesh_terms: D000227:Adenine Nucleotides / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D001087:Arabinonucleosides / Q000008:administration & dosage*; D000077866:Clofarabine; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000227:Adenine Nucleotides; D001087:Arabinonucleosides; D000077866:Clofarabine; D014740:Vidarabine; C024352:fludarabine
keywords: Clofarabine; Relapsed/refractory AML; Salvage therapy